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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412021
Report Date: 10/11/2023
Date Signed: 10/11/2023 05:03:29 PM

Document Has Been Signed on 10/11/2023 05:03 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:MONTESSORI WAYFACILITY NUMBER:
434412021
ADMINISTRATOR:BEHJAT GHAMARIFACILITY TYPE:
850
ADDRESS:4245 MEG DRIVETELEPHONE:
4084481499
CITY:SAN JOSESTATE: CAZIP CODE:
95136
CAPACITY: 43TOTAL ENROLLED CHILDREN: 40CENSUS: 31DATE:
10/11/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Behjat GhamariTIME COMPLETED:
05:10 PM
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Licensing Program Analyst (LPA) Jessica Bongardt and Licensing Program Manager (LPM) Diana Stephenson met with Behjat "Betty" Ghamari, Director, for an unannounced Required - 1 Year inspection. LPA and LPM toured the indoor and outdoor areas of the Facility with Betty during today's inspection. LPA and LPM observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), Menus were not readily available in Classroom C because it is only posted in Classroom A & B, and Activity Schedule. Days and hours of operation are Monday through Friday 7:30AM to 6:00PM The facility is licensed to serve a maximum of 43 children, Classroom C Toddler Option 18 Months to 36 Months 10 children and Classroom A & B is the preschool 33 children.

LPA and LPM reviewed 11 children's and 7 staff files during today's inspection. There was no child roster present. Each child's file reviewed did contain all required forms/documents, including Admission Agreement, Emergency Medical Consent (LIC 627), and Information and Emergency Information form (LIC 700). All staff files reviewed did not contain the required forms/documents, including transcripts/verification of experience/immunization records, and Health Screening Report (LIC 503). Only Yesenia Lopez has completion of the Mandated Reporter Training for Child Care Workers on file. According to files only Natalie Lopez and Manjeet Sihra had a current CPR and First Aid certifications on file however Natalies card does not have an expiration date on it, but was completed on 10/18/2022. LPA and LPM advised director to have the card fixed. Betty 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). Last fire/disaster drill was completed on 09/29/2023, due to being part of a school they follow the school fire drill schedule.

LPA and LPM observed that the teacher/child ratio was in compliance during today's inspection. LPA and LPM observed 9 Children in the toddler option and 2 staff and 22 children and 3 staff in with the preschool during today's inspection. Betty understands the conditions, limitations, and capacity specifications of the Facility license. Betty understands that children shall be visually supervised at all times. Any child(ren) who exhibit symptoms of illness including, but not limited to, fever or vomiting, are not accepted in care. Any child(ren) who become ill during the day, shall be isolated in the director’s office area. There is not an IMS plan however they do administer medication to children.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Jessica Bongardt
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: MONTESSORI WAY
FACILITY NUMBER: 434412021
VISIT DATE: 10/11/2023
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LPA and LPM observed that the Facility is clean, safe, sanitary, and in good repair for children, staff, and visitors. Director states that the Facility has the janitorial staff from the school clean the rooms. Director understands that the Facility must be kept free of flies and other insects & rodents. LPA and LPM observed that all furniture and equipment is in good condition and safe for the children. There are water fountains outside that the children use and they also bring their own water bottles and those are are also filled from faucet water inside the classroom.

LPA and LPM observed there is cold running water, a refrigerator and microwave on the premises. Lunch is prepared on site and also brought from home. The Facility has trash cans with tight fitting lids for solid waste in the classroom. Cleaning supplies are inaccessible to the children and stored in cabinets located in areas off limits to children. There are two diaper changing areas, two toilets, one urinal, and 3 sinks for the children to use. LPA and LPM observed a complete first aid kit available in the facility.

The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA and LPM observed that the outdoor equipment is age appropriate and in good condition. Shade rest areas are provided by a canopy. There is sufficient resilient materials on the outdoor playground area. LPA and LPM did not observe any bodies of water. Director states that the Facility does not provide transportation for preschool children.

Director was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

This facility does provide Incidental Medical Services. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, Director needs to provide a 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Jessica Bongardt
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023
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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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: MONTESSORI WAY
FACILITY NUMBER: 434412021
VISIT DATE: 10/11/2023
NARRATIVE
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LPA and LPM discussed the safe sleep regulations with 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. LPA and LPM also 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.

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). Director informed LPA and LPM that the school district conducted the tested and the director will provide the department with the findings.

Director understands that children's personal rights should not be violated; including no unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature.

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/inspection-process

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Jessica Bongardt
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023
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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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: MONTESSORI WAY
FACILITY NUMBER: 434412021
VISIT DATE: 10/11/2023
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LPA and LPM provided 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

Exit interview conducted and report was reviewed with Betty, Director. Deficiencies were cited on the 809D and appeal rights given to Director during today's inspection.

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Jessica Bongardt
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023
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Document Has Been Signed on 10/11/2023 05:03 PM - It Cannot Be Edited


Created By: Jessica Bongardt On 10/11/2023 at 03:33 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: MONTESSORI WAY
FACILITY NUMBER: 434412021

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/11/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101226(e)
Health-Related Services
(e) In centers where the licensee chooses to handle medications:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and record review, the licensee did not comply with the section cited above pertaining to child identified as C6who has an Epi Pen and an Inhaler at the school which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/25/2023
Plan of Correction
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2
3
4
Director needs to submit IMS Plan sent to LPA no later than POC date
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 on record reviews, the licensee did not comply with the section cited above in five of the seven staff files that were reviewed which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/25/2023
Plan of Correction
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Director will submit copies of the Mandated Reporter certificates no later than the POC due date to LPA
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:Diana Stephenson
LICENSING EVALUATOR NAME:Jessica Bongardt
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/11/2023 05:03 PM - It Cannot Be Edited


Created By: Jessica Bongardt On 10/11/2023 at 03:33 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: MONTESSORI WAY
FACILITY NUMBER: 434412021

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/11/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on record reviews, the licensee did not comply with the section cited above in five out of seven staff files which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/25/2023
Plan of Correction
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Director will submit copies if Immunization records and either Flu shot Vaccines or letters opting out of the Flu vaccines to LPA by POC due date.
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
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Based on record review, the licensee did not comply with the section cited above in three out of seven staff files which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/25/2023
Plan of Correction
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Director will submit copies of Heath Screenings and TB tests to LPA by POC due date.
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:Diana Stephenson
LICENSING EVALUATOR NAME:Jessica Bongardt
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2023


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Document Has Been Signed on 10/11/2023 05:03 PM - It Cannot Be Edited


Created By: Jessica Bongardt On 10/11/2023 at 03:33 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: MONTESSORI WAY
FACILITY NUMBER: 434412021

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/11/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(2)
Personnel Requirements
(2) Each person specified in (g) above shall have a health-screening report signed by the person performing the screening. This report shall indicate the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record reviews, the licensee did not comply with the section cited above in three of seven staff files reviewed which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/25/2023
Plan of Correction
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2
3
4
Director will submit copies of the signed Health Screenings to LPA by POC Due Date.
Type B
Section Cited
CCR
101220(a)
Child's Medical Assessments
(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on record reviews, the licensee did not comply with the section cited above in five out of eleven childrens files that were reviewed which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/25/2023
Plan of Correction
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4
Director will submit copies of childrens Physican Reports to LPA by POC Due Date.
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:Diana Stephenson
LICENSING EVALUATOR NAME:Jessica Bongardt
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2023


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Document Has Been Signed on 10/11/2023 05:03 PM - It Cannot Be Edited


Created By: Jessica Bongardt On 10/11/2023 at 03:33 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: MONTESSORI WAY
FACILITY NUMBER: 434412021

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/11/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101429(a)(2)(C)
Responsibility for Providing Care and Supervision for Infants
(C) Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record reviews, the licensee did not comply with the section cited above in three out of three infant files where 15-minute sleep checks are requied which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/25/2023
Plan of Correction
1
2
3
4
Director will sumbit copies of the sleep logs for the three children under two years old who require sleep checks by POC Due Date.
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.
SUPERVISOR'S NAME:Diana Stephenson
LICENSING EVALUATOR NAME:Jessica Bongardt
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2023


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