444408900-1-3-2024-07-CC-CNEN-CZ5UUF-20240103145327

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444408900
Report Date: 01/03/2024
Date Signed: 01/03/2024 02:53:57 PM

Document Has Been Signed on 01/03/2024 02:53 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	MONTESSORI COMMUNITY SCHOOL		FACILITY NUMBER:	444408900
ADMINISTRATOR:	MADELYNN VAN DEN HEUVEL		FACILITY TYPE:	830
ADDRESS:	123 SOUTH NAVARRA DRIVE		TELEPHONE:	(831) 439-9313
CITY:	SCOTTS VALLEY	STATE: CA	ZIP CODE:	95066
CAPACITY:	12	CENSUS: 2	DATE:	01/03/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	12:21 PM
MET WITH:	Madelynn Van Den Heuvel		TIME COMPLETED:	03:03 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA), Cortney Nelson, met with Site Director, Madelynn Van Den Heuvel, for an unannounced Required- 1 Year Inspection. LPA was granted access to the facility by Aurora Tershy and toured both indoors and outdoors during the inspection. Upon arrival, there were two (2) infants and one teacher present, which is compliant with the facility license capacity and ratio requirements. The facility is currently hosting winter break camp this week, so the attending number of children is low today. LPA observed all required postings near the entrance to the facility and the hours of operation are Monday – Friday, 7:30AM-5:30PM. The Licensee 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. LPA reviewed digital sign-in/out sheets on Procare, the facility roster (LIC9040), and the fire/disaster drill log during today’s inspection. The last fire/disaster drill was conducted on 11/14/2023, which is compliant with the six-month requirement for facilities. LPA observed a fully charged 3A40BC fire extinguisher (last serviced: 9/2023), functioning smoke detector and carbon monoxide detector. Madelynn states that she does not currently have any children in care who require Incidental Medical Services and does not administer medication at this time. There are no weapons or firearms on the premises. Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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/.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MONTESSORI COMMUNITY SCHOOL	FACILITY NUMBER: 444408900
	VISIT DATE: 01/03/2024

NARRATIVE

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Indoor areas of the facility were inspected by the LPA today and observed to be clean, orderly, and safe for day care infants. The infant room (Nido) is physically separate from other childcare center components at the facility. LPA observed sufficient age-appropriate materials, toys, and play equipment for infants. Toys are safe and do not have sharp edges or small parts that may pose a choking hazard. The infant changing table was observed to be padded, within arms reach of a sink, in good repair and safe condition. Montessori Cots used by the infants are free from loose articles, covered with a fitted sheet, and there are no objects hanging above or attached to the crib. The floors are clean and free of tripping hazards and waste containers have tight fitting lids.

LPA reminded Madelynn that infant Needs and Services plan shall be updated at least quarterly and shall be completed with the infants authorized representative and a representative from the facility, such as a director or lead teacher. The facility sends daily forms home with parents about the infants day, however LPA advised that the Needs and Services plan shall still be completed quarterly and retained in the infant's file. The feeding plan is current for all infants and Madelynn understands that all formula and bottles provided should be labeled individually with the child’s name and date.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee 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.

The outdoor area of the facility was inspected and observed to be physically separated from space utilized by other child care center components. LPA observed that the fence between the preschool and infant yard are barrels next to each other and advised that the fence separating components shall be at least four feet tall. Some barrels are in disrepair and do not fully separate the outdoor areas for the components. LPA observed outdoor area for infants is in good condition and age-appropriate. No outdoor bodies of water were observed during today’s inspection. Shaded rest area is provided by canopy and patio overhang.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

LIC809 (FAS) - (06/04)

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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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MONTESSORI COMMUNITY SCHOOL	FACILITY NUMBER: 444408900
	VISIT DATE: 01/03/2024

NARRATIVE

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Five (5) children’s files were reviewed and most required documents were present. One (1) staff file was reviewed and LPA advised that infant staff shall have three (3) units related to the care of infants. There is at least one staff member with current First-Aid/CPR that expires 8/23/2025 and Mandated Reporter certificate that expires 5/22/2024. LPA reminded that both shall be updated every two years.

Madelynn understands she shall be on the premises during the hours the center is in operation and that infants at the center shall be visually supervised at all times. LPA reminded 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, such as field trips.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

Exit interview conducted and report was reviewed with the Site Director, Madelynn Van Den Heuvel.

As a result of today’s inspection, deficiencies were cited, see LIC809-D.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/03/2024 02:53 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MONTESSORI COMMUNITY SCHOOL	FACILITY NUMBER: 444408900
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/03/2024

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
1 2 3 4	Based on record review and interview, the licensee did not comply with the section cited above for the infant component, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/15/2024
	Plan of Correction
1 2 3 4	The facility shall arrange for water lead testing and submit proof of scheduled lead testing date to the Department by 1/15/2024. LPA advised completing all necessary licensing documents for water lead testing including LIC9275, LIC9276, and LIC999 with all faucets tested clearly labeled.

Type B

Section Cited

CCR

101238.2(g)

Outdoor Activity Space

(g) The playground shall be enclosed by a fence to protect children and to keep them in the outdoor activity area. The fence shall be at least four feet high. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above as the infant fence is made of wooden barrels that are in disrepair and does not physically separate the component yards, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/15/2024
	Plan of Correction
1 2 3 4	The facility shall submit a plan of correction for the fence to the Department by 1/15/2024. LPA advised that the fence shall be at least four feet high and shall be enclosed around the outdoor area.

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: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/03/2024 02:53 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MONTESSORI COMMUNITY SCHOOL	FACILITY NUMBER: 444408900
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/03/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101416.2(c)(1)(A)

Infant Care Teacher Qualifications and Duties

(c) To be a fully qualified infant care teacher, a teacher shall have the following: (1) Completion, with passing grades, of 12 postsecondary semester or equivalent quarter units in early childhood or child development education at an accredited or approved college or university. (A) At least three of the units required in (c)(1) above shall be related to the care of infants or shall contain instruction specific to infants. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above as one teacher working with the infants today does not have three units pertaining to the care of infants, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/15/2024
	Plan of Correction
1 2 3 4	The facility shall submit a list of staff that are qualified to work with infants to ensure that staff who are not qualified are not working alone with infants. List of infant staff to be submitted by 1/15/2024. If staff member shall continue to assist with infants, she shall enroll into a course and submit proof by 1/15/2024.

Type B

Section Cited

CCR

101419.2(a)

Infant Needs and Services Plan

(a) Prior to the infant's first day at the center, the infant care center director or assistant director shall complete a needs and services plan for the infant. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review and interview, the licensee did not comply with the section cited above as parents are directed to complete the infant needs and services plan, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/15/2024
	Plan of Correction
1 2 3 4	The facility shall create an updated Needs and Services plan that has signature for both the authorized representative and director/assistant director/lead teacher to sign once it has been updated. Updated document to be submitted to the Department by 1/15/2024.

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: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/03/2024 02:53 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MONTESSORI COMMUNITY SCHOOL	FACILITY NUMBER: 444408900
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/03/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101419.3(a)

Modifications to Infant Needs and Services Plan

(a) The written infant needs and services plan shall be updated at least quarterly, or as often as necessary to assure its accuracy. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above as one out of five infants had a Needs and Services plan updated in the last quarter, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/15/2024
	Plan of Correction
1 2 3 4	The facility shall update infant Needs and Services plan and submit proof of completion for four infants to the Department by 1/15/2024.

Type B

Section Cited

CCR

101229.1(a)(1)

Sign In and Sign Out

(a) In addition to the sign-in procedure requirement of Section 101226.1(b), the licensee shall develop, maintain and implement a written procedure to sign the child in/out of the child care center that shall, at a minimum, include the following: (1) The person who signs the child in/out shall use his/her full legal signature and shall record the time of day. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and observation, the licensee did not comply with the section cited above as parents are not prompted to sign-in after scanning the QR code, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/15/2024
	Plan of Correction
1 2 3 4	The facility shall revise Procare app to prompt for signature after scanning the QR code and also confirm that the signatures can be reviewed for future annual inspections. The facility shall submit proof of signature review capability of Procare to the Department by 1/15/2024.

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: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

LIC809 (FAS) - (06/04)

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