430709483-3-14-2025-07-CC-MKAR-DEQQRD-20250313122346

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430709483
Report Date: 03/13/2025
Date Signed: 03/14/2025 03:50:11 PM

Document Has Been Signed on 03/14/2025 03:50 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	DELOR MONTESSORI		FACILITY NUMBER:	430709483
ADMINISTRATOR/ DIRECTOR:	MCGEOY, LORI		FACILITY TYPE:	850
ADDRESS:	1510 LEWISTON DRIVE		TELEPHONE:	(408) 773-0200
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94087
CAPACITY: 92	TOTAL ENROLLED CHILDREN: 42	CENSUS: 37	DATE:	03/13/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:57 AM
MET WITH:	Priti Shastri		TIME VISIT/ INSPECTION COMPLETED:	12:42 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), Mandeep Kaur met with Assistant Director, Priti Shastri, for an unannounced-Annual/Random inspection The purpose of today's inspection was explained with Assistant Director. Facility's License, Notification of Parents’ Right Poster, Child Car Seat Law, Personal Rights (LIC 613A), Emergency Disaster Plan, Menus, Activity Schedule, and Earthquake Preparedness Checklist were observed to be posted. The center's operating hours are Monday through Friday from 07:30 AM to 5:30 PM. The facility is licensed to serve preschool children ages 2 years to entry into first grade in classrooms: P2, P3, younger 2 years old classroom, 2 to 3 and half years old classroom. The Facility has Toddler component to serve children ages 18 months to 30 months in Toddler classroom. LPA toured the indoor and outdoor areas. LPA observed that the two teacher aids (S3 & S4) were present with the children without a qualified teacher. Assistant Director stated that both teacher aids(S3 & S4) are with younger two years old classroom. Assistant Director was reminded of having a qualified Teacher in the classroom. Fire drill was conducted on February 26, 2025. The facility has current children's roster and a copy was provided to LPA during the inspection. Cleaning products, disinfectants, sharp objects were stored inaccessible to children. Furniture and equipment were observed to be age appropriate and in good condition. The bathrooms for children and staff are sanitary, and operable. Assistant Director stated that the center has a third party cleaning service that comes and clean the facility after daycare hours. The center provides morning snacks and afternoon snacks to the children. There is a kitchen at the facility for food preparation. The kitchen is equipped with a refrigerator, microwave, storage space for food, and a sink with hot and cold running water. Drinking water is available for the children indoor filtered water and sippy cups. LPA observed trash cans with tight fitting covers for the disposable of solid waste. The facility has fire extinguishers and working smoke and carbon monoxide detectors. *Continuation on next pages:*

Belinda Devall	TELEPHONE: (408) 598-5501
Mandeep Kaur	TELEPHONE: 408-334-8320
	DATE: 03/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: DELOR MONTESSORI	FACILITY NUMBER: 430709483
	VISIT DATE: 03/13/2025

NARRATIVE

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The playground is surrounded with appropriate fencing and the outdoor surfaces are safe. Shade is provided. Drinking water is readily available for the children outdoor filtered water and sippy cups. LPA observed climbing structures with resilient material under and around the structures. There were no bodies of water observed. Assistant Director stated that there are no weapons or firearms on the premises.

LPA reviewed 5 random children's files. Children records reviewed include Admission Agreement,
Identification and Emergency Information, Consent for Emergency Medical Treatment, Physician's Report, TB test, Immunizations, Parent Right's Receipt, Personal Rights, and Health History.

LPA reviewed 5 staff files. Staff records reviewed include Employee Rights, Statement Acknowledging
Requirement to Report Child Abuse, Health Screening Report with TB Clearance, Immunizations (Measles,
Pertussis, and Influenza) and required training. Based on record review, one out of five of the staff (S5)has expired Mandated Reporter Training, two out of five staff (S1 & S5) are missing health screening form and staff (S5) is missing TB test results. LPA reminded Assistant Director that the Mandated Reporter Training shall be renewed by all staff every two years. At least one staff member present during the inspection has current Pediatric CPR/First Aid certifications.

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/.

Assistant 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.

Continuation on next page:

SUPERVISOR'S NAME: Belinda Devall	TELEPHONE: (408) 598-5501
LICENSING EVALUATOR NAME: Mandeep Kaur	TELEPHONE: 408-334-8320
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: DELOR MONTESSORI	FACILITY NUMBER: 430709483
	VISIT DATE: 03/13/2025

NARRATIVE

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LPAs discussed the safe sleep regulations with Site Director 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. LPAs also informed Site 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.

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.

Assistant 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&R's) throughout California.

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.

As a result of this inspection, Three Type B deficiencies were cited on the following pages-809D. Appeal Rights provided.
Exit interview conducted and report was reviewed with Assistant Director, Priti Shastri. .
A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Belinda Devall	TELEPHONE: (408) 598-5501
LICENSING EVALUATOR NAME: Mandeep Kaur	TELEPHONE: 408-334-8320
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/14/2025 03:50 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: DELOR MONTESSORI	FACILITY NUMBER: 430709483
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/13/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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
1 2 3 4	Based on records review, the licensee did not comply with the section cited above in one out of five staff (S5) does not have current Mandated reporter Training certificate (AB1207) on file, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/27/2025
	Plan of Correction
1 2 3 4	By plan of correction, due date 03/27/2025, licensee will submit the current Mandated reporter Training (AB1207) certificate to the department for staff (S5).

Type B

Section Cited

CCR

101216(g)(1)

Personnel Requirements

(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure. 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 in two out of five staff (S1 & S5) does not have health screening on file. Staff (S5) is does not TB test results on file, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/27/2025
	Plan of Correction
1 2 3 4	By plan of correction, due date 03/27/2025, licensee will submit the copy of the health screening for staff (S1 & S5) and TB test results for staff (S5) to the department.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Belinda Devall	TELEPHONE: (408) 598-5501
Mandeep Kaur	TELEPHONE: 408-334-8320
	DATE: 03/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

LIC809 (FAS) - (06/04)

Page: 4 of 5

Document Has Been Signed on 03/14/2025 03:50 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: DELOR MONTESSORI	FACILITY NUMBER: 430709483
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/13/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

CCR

101216.2(e)

Teacher Aide Qualifications and Duties

(e) An aide shall work only under the direct supervision of a teacher. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, nterviews and record review, the licensee did not comply with the section cited above. LPA observed two teacher aids (S3 & S4) were present with the younger two year old children without any qualified teacher present in the classroom, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/13/2025
	Plan of Correction
1 2 3 4	Deficiency was cleared during the inspection as Assistant Director combined the two classrooms while a qualified teacher was present in the classroom while being in ratio.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Belinda Devall	TELEPHONE: (408) 598-5501
Mandeep Kaur	TELEPHONE: 408-334-8320
	DATE: 03/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

LIC809 (FAS) - (06/04)

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