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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 440700557
Report Date: 10/18/2023
Date Signed: 10/19/2023 10:12:51 AM

Document Has Been Signed on 10/19/2023 10:12 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:SANTA CRUZ MONTESSORI SCHOOLFACILITY NUMBER:
440700557
ADMINISTRATOR:KIMBERLEY SAXTONFACILITY TYPE:
850
ADDRESS:6230 SOQUEL DRIVETELEPHONE:
(831) 476-1646
CITY:APTOSSTATE: CAZIP CODE:
95003
CAPACITY: 112TOTAL ENROLLED CHILDREN: 65CENSUS: 59DATE:
10/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Kimberley SaxtonTIME COMPLETED:
03:10 PM
NARRATIVE
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On 10/18/2023 at 9:00am, Licensing Program Analyst (LPA), Farida Raja, met with Director, Kimberley Saxton, for an unannounced Required 1-Year inspection in the preschool program. The facility is licensed to serve children ages 3 years to entry into 1st grade in four rooms. LPA observed the required posted materials in the front office. Days and hours of operation are Monday through Friday, 7:30AM to 4:30PM.

LPA toured the indoor and outdoor areas of the facility and observed the following ratios in each classroom:

Willow Room: 4 Teachers and 15 Children
Monarch Room: 2 Teachers and 13 Children
Ohlone Room: 4 Teachers and 16 Children
Redwood Room: 3 teachers and 15 Children

Facility was in compliance with teacher to children ratio requirement. The classrooms, children's restrooms, staff restroom, nap room, observation room and office area were inspected. Children were engaged in various activities with assistance from and under visual supervision of teachers. Facility has central heating/cooling for comfort of children. Director states that there are no weapons or firearms on the premises. There is a working telephone at the facility (831-476-1646). Disinfectants and cleaning products were stored on high shelves in the children's bathroom and in an outdoor storage area. Medication is stored in each classroom on high shelves near the food preparation area. Director stated that if medication requires refrigeration it is stored in the refrigerator in the staff break room. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. Floors were clean and free from tripping hazards. Napping equipment was observed to be in good condition. Restrooms and sinks for children were observed to be safe, sanitary, and in working condition. LPA observed trash cans with tight fitting lids in all classrooms. Director stated that the facility is cleaned on a daily basis by an outside agency.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE: DATE: 10/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/18/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 10/19/2023 10:12 AM - It Cannot Be Edited


Created By: Farida Raja On 10/18/2023 at 01:42 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SANTA CRUZ MONTESSORI SCHOOL
FACILITY NUMBER: 440700557

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/18/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, the licensee did not comply with the section cited above in which poses a potential health, safety or personal rights risk to persons in care. Director stated that facility has not completed the water lead testing.
POC Due Date: 11/08/2023
Plan of Correction
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Director scheduled the water lead testing for 11/04/2023 while LPA was present and with submit proof of completed testing along with the required forms to LPA by plan of correction date of 11/08/2023.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based record review and interview, the licensee did not comply with the section cited above for staff, S2, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/01/2023
Plan of Correction
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Director will submit certificate of completed mandated reporter training for staff, S2, by plan of correction date of 11/01/2023.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Gladys Kuizon
LICENSING EVALUATOR NAME:Farida Raja
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2023


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Document Has Been Signed on 10/19/2023 10:12 AM - It Cannot Be Edited


Created By: Farida Raja On 10/18/2023 at 01:42 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SANTA CRUZ MONTESSORI SCHOOL
FACILITY NUMBER: 440700557

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/18/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101226(e)(3)(A)
Health-Related Services
(3) Prescription medications may be administered if all of the following conditions are met: (A) Prescription medications shall be administered in accordance with the label directions as prescribed by the child's physician.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above for child, C1, which poses a potential health, safety or personal rights risk to persons in care. LPA observed child (C1) epi pen and benadryl medication is expired and has not been returned or renewed by facility.
POC Due Date: 10/25/2023
Plan of Correction
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Director shall submit a written plan of how the center will check expiration dates on medications and request renewal or return expired medication to authorized representatives. Director will return C1s medication and obtain new medication for the child in care. Director will send proof of correction to LPA by 10/25/2023.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Gladys Kuizon
LICENSING EVALUATOR NAME:Farida Raja
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2023


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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SANTA CRUZ MONTESSORI SCHOOL
FACILITY NUMBER: 440700557
VISIT DATE: 10/18/2023
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LPA observed fire extinguishers and working smoke and carbon monoxide detectors in each classroom. Log shows that the last Fire Drill was conducted on 09/21/2023 which is compliant with the six-month requirement for facilities.

Drinking water inside the classrooms and in the playground is provided by water dispensers and individually labelled cups. Childcare Center did not complete the water lead testing prior to the deadline. Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. LPA referred director to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Meals and snacks are not provided by the facility. Director stated that parents rotate to provide snacks for the entire classroom. Parents are provided with a list of the foods children like and a list of foods that children are allergic to. Children bring lunches from home. Foods and beverages were stored safely to prevent contamination and spoilage. Food storage and preparation areas were observed to be sanitary.

Outdoor playground and play equipment was inspected and observed to be fenced in and free of hazards. LPA observed play equipment was in good condition and age-appropriate. Sand box was observed to be covered. Areas around and under high climbing equipment and slides were cushioned with wood chips as resilient material to absorbs falls. Rubber mats are also placed as cushioning material. Shaded rest area is provided by building overhang, wooden awnings, trees and canopy.

Children sign in and out procedures and logs were reviewed. Children's roster was reviewed, and a copy was provided to the LPA. LPA reviewed twelve (12) children's files during today's inspection. Each child's file reviewed contained the required forms.

LPA informed director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2023
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SANTA CRUZ MONTESSORI SCHOOL
FACILITY NUMBER: 440700557
VISIT DATE: 10/18/2023
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LPA reviewed four (4) staff files. All staff files reviewed contain the required transcripts/verification of experience. All staff files reviewed have a current CPR and First Aid certification. Director understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips). All staff have the required Immunization's against pertussis, measles and influenza (or statement declining influenza). LPA reviewed the required Mandated Reporter Training for staff. One staff (S2) did not have a current Mandated Reporter Training.

Director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

This facility does handle medications and currently has children in care who require Incidental Medical Services and LPA observed the medication is properly stored out of reach of children. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. Facility has an approved IMS Plan on file with San Jose Regional Office. LPA observed child (C1) medication is expired and has not been returned or renewed by facility. Isolation of sick child was discussed, and Director explained that sick children will be isolated in the community room and isolation equipment will be provided. The office restroom in the hallway is used if necessary. Child is always under visual supervision while in care of the facility. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Facility does not provide transportation to children, but Director understands that children cannot be left alone, unattended in parked vehicles.

Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2023
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SANTA CRUZ MONTESSORI SCHOOL
FACILITY NUMBER: 440700557
VISIT DATE: 10/18/2023
NARRATIVE
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Director will submit an updated Emergency Disaster Plan (LIC 610) including relocation letters if required by 11/01/2023. Director submitted an updated Designation of Facility Responsibility (LIC 308) during today's visit.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

Three (3) Type B deficiencies were cited today on the attached LIC 809D pages. Appeal rights were printed and provided to Director. LPA reminded Director that failure to correct deficiencies by Plan of Correction Due Date may result in penalties of $100 per day per violation. Exit interview conducted and report was reviewed with the Director, Kimberley Saxton.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2023
LIC809 (FAS) - (06/04)
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