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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710435
Report Date: 05/29/2024
Date Signed: 05/30/2024 09:19:56 AM

Document Has Been Signed on 05/30/2024 09:19 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:MONTAGUE DISTRICT/STATE PRESCHOOLFACILITY NUMBER:
430710435
ADMINISTRATOR/
DIRECTOR:		GINA PEREZFACILITY TYPE:
850
ADDRESS:750 LAURIE AVENUETELEPHONE:
(408) 423-1931
CITY:SANTA CLARASTATE: CAZIP CODE:
95054
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 14DATE:
05/29/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:55 PM
MET WITH:Zaithed Arias TIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Anna Morales conducted an Unannounced-3 Year Required Inspection. LPA was greeted by Director Zaithed Arias. Days and hours of operation is Monday- Friday:8:15am-11:15am for Classroom Numbers 26 and 27, Classroom Number 28 (District)-7:15am-5:30pm(full day) and 8:15am-11:45am(half day), serving ages from two years-entry to First Grade. Facility's License, Notification of Parents’ Rights Poster, Child Car Seat Law, Personal Rights (LIC 613A), Emergency Disaster Plan, and Earthquake Preparedness Checklist were observed to be posted. Disaster Drill was conducted on 4/24/24. The Facility has one waiver shared bathroom usage. The Facility is in compliance with the terms and conditions of all waivers.

The Preschool Program is operating in three classrooms, #26, #27(State Preschool) and #28 (District). LPA observed 14 children and three staff in Classroom #28. (Preschool Classroom Number 26 and 27 end their program at 11:15am).The State preschool is Title V funded and thus must comply with Title V ratio requirements at all times.

LPA toured the facility both indoor and outdoor. Children were taking naps with supervision of staff. If a child comes to the facility who exhibit symptoms of illness including, but not limited to, fever or vomiting, they are not accepted into care. Any child who become ill during the day, shall be isolated until parent pick-up.
There were no bodies of water observed. Director stated that they do not have weapons on the premises. Furniture and equipment were observed to be age appropriate and in good condition, free of sharp, loose, or pointed parts. Disinfectants, cleaning solutions, and other items that are dangerous to children were stored inaccessible to children. Floors were clean. LPA observed cubbies for the children's personal belongings.
LPA observed charged Fire extinguishers. LPA observed Carbon and Smoke detector. Foods and beverages were kept protected against contamination and spoilage. Trash cans for solid waste had tight-fitting covers on and were in good repair.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE: DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/29/2024
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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: MONTAGUE DISTRICT/STATE PRESCHOOL
FACILITY NUMBER: 430710435
VISIT DATE: 05/29/2024
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Outdoor activity spaces are enclosed by fencing and are observed to be free of hazards. LPA observed play equipment were in good condition. LPA observed shade provided by playground structure.. Drinking water was readily available to children indoor and outdoor. Activities schedule, Breakfast, lunch and Snack Menu were posted. Facility provides breakfast, lunch and snacks in the morning and in the afternoon( school district provides). LPA provided the Program Director with website resources on managing food allergies at school and handling medical emergencies related to food allergies.
CDC Managing Food Allergies at School
https://www.cdc.gov/healthyschools/foodallergies/index.htm
American Academy of Pediatrics Healthy Children Medical Emergencies
https://www.healthychildren.org/English/health-issues/injuries-emergencies/Pages/When-to-Call-Emergency-Medical-Services-EMS.aspx

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of "medication and equipment/supplies, and reviewed children's, personnel, and administration records. 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 and link to publication. Commonly Asked Questions about Child Care Centers and the ALPDA are available at: https://www.ada.gov/resources/child-carecenters/.

The facility maintains an electronic sign in and out system, that is updated throughout the day, containing full signatures from responsible parties. The facility maintains an updated roster of children enrolled in the program electronically through the same program.

A sampling of children and staff files was taken for review during today's inspection. Children records reviewed include Admission Agreement, Identification and Emergency Contact, Consent for Emergency Medical Treatment form, receipt of Parent Rights Notice, Personal Rights Notice, Medical Assessment and Immunizations.
Staff records reviewed include Health Screening Report and TB test, Immunization (Measles, Pertussis, and Flu) record and required Training. LPA reminded Director that the online AB1207 Mandated Reported Training needs to be renewed every two years. There was at least one person with current certification in Pediatric CPR and First Aid present at the facility.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024
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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: MONTAGUE DISTRICT/STATE PRESCHOOL
FACILITY NUMBER: 430710435
VISIT DATE: 05/29/2024
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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). LPA verified that the lead testing was completed in accordance to the Written Directives.

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

No deficiencies were cited at today's inspection. Exit interview was conducted and reviewed with Director. Notice of site visit was given and must remain posted for 30 days.
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.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024
LIC809 (FAS) - (06/04)
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