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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412021
Report Date: 06/21/2024
Date Signed: 06/21/2024 04:03:09 PM

Document Has Been Signed on 06/21/2024 04:03 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:MONTESSORI WAYFACILITY NUMBER:
434412021
ADMINISTRATOR/
DIRECTOR:
BEHJAT GHAMARIFACILITY TYPE:
850
ADDRESS:4245 MEG DRIVETELEPHONE:
(408) 448-1499
CITY:SAN JOSESTATE: CAZIP CODE:
95136
CAPACITY: 43TOTAL ENROLLED CHILDREN: 42CENSUS: 28DATE:
06/21/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Behjat GhamariTIME VISIT/
INSPECTION COMPLETED:
02:50 PM
NARRATIVE
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On 06/21/2024 at 11:30am, Licensing Program Analyst (LPA), Farida Raja arrived to conduct an unannounced case management inspection to check compliance for deficiencies cited during an Required - 1 year inspection on 10/11/2023. LPA met with Director, Behjat Ghamari and informed her of the purpose for the visit. The facility was cited for failure to submit an Incidental Medical Services (IMS) plan prior to administering IMS services and missing staff and children’s required forms. Facility was also issued a technical violation for failure to conduct water lead testing prior to the deadline. LPA met with Behjat Ghamari and informed her of the purpose of today’s inspection.

LPA conducted a facility walk through and observed the following ratios:
Room G-27: 1 teacher: 2 children
Room G-28: 3 teachers :15 children

LPA reviewed children’s and staff records and obtained a copy of the Incidental Medical Services (IMS) Plan. Through file review LPA observed staff, S1 is missing the Health Screening (LIC 503) conducted by physician, Staff, S1 and S3 are missing immunization's for measles and pertussis and child C4 and C8 are missing the Physician's Report (LIC 701). Repeat Type B violations are being cited for these deficiencies. Facility is in repeat violation for above citations within a 12 month period.

Based on interview, Director stated that the water lead testing was completed by School District as they are located on the premises of Rachel Carson Elementary School and provided a copy of the water lead test report to LPA. Director stated that not all water outlets used for drinking and food preparation purposes in the Montessori Way classrooms and outdoor areas were tested. LPA informed Director that the water lead testing requirements for the school district were different from the ones required for childcare centers and that all water outlets used for drinking and food preparation need to be tested. LPA provided Director with a copy of PIN 21-21.2-CCP.

Continued on Page 2
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2024
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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: MONTESSORI WAY
FACILITY NUMBER: 434412021
VISIT DATE: 06/21/2024
NARRATIVE
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During Required – 1 year inspection conducted on 10/11/2023, Director was informed that since the business has changed from sole proprietorship to a corporation the Licensee will need to submit a new application for change of ownership. Licensee submitted a new application on 11/27/2023 but withdrew the application on 06/06/2024 stating that she will continue to operate as an individual proprietor. Based on review of lease agreement from 06/01/2022, the lease is between the San Jose Unified School District and Montessori Way, Inc., a California corporation ("Tenant"). Lease agreement confirms that facility is currently operating as a corporation (Montessori Way, Inc.). Based on interview with Director, she stated that since they withdrew the application just last week she has not made any changes to the lease and was in the process of communicating and working with the Centralized Application Bureau (CAB) to present a lease. One technical violation was issued. Director will submit a new lease agreement to Childcare Licensing showing proof of control of property.

Deficiencies issued on 10/11/2023 for missing Mandated Reporter Training's, 15 minute nap check log and Incidental Medical Services (IMS) plan are corrected and were cleared during today's inspection.

As a result of this inspection, one technical violation and Type B deficiencies including repeat violations were issued. Civil penalties of $750 were issued as a result of repeat violations. Exit Interview was conducted, where this report, the citations, plan of corrections, and appeal rights were reviewed and discussed with Director, Behjat Ghamari. LPA reminded Licensee that failure to correct deficiencies by Plan of Correction Due Date may result in civil penalties of $100 per day per violation until the correction is made.

LPA had technical difficulties with printer and emailed a copy of the reports to Director, Behjat Ghamari.

A NOTICE OF SITE VISIT WAS ISSUED, AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 06/21/2024 04:03 PM - It Cannot Be Edited


Created By: Farida Raja On 06/21/2024 at 01:01 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: 06/21/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/05/2024
Section Cited
HSC
1596.7995(a)(1)

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1596.7995 (a)(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:
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Director to submit proof of immunizations for two staff by plan of correction date of 07/05/2024.
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Based on records reviewed, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. Staff, S1 and S3 are missing proof of immunizations for measles and pertussis.
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Type B
07/05/2024
Section Cited
CCR101216(g)(1)

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(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:
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Director to submit proof of Heath Screening and TB test for one staff to LPA by plan of correction date of 07/05/2024.
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Based on record review, the licensee did not comply with the section cited above for one staff (S1) which poses a potential health, safety or personal rights risk to persons in care.
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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: 06/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2024


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 06/21/2024 04:03 PM - It Cannot Be Edited


Created By: Farida Raja On 06/21/2024 at 01:36 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: 06/21/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/05/2024
Section Cited
HSC
1597.16(a)(1)

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(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:
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Director will complete water lead testing and submit report along with the required forms to LPA by 07/05/2024.
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Based on interview, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. Director stated that the water lead testing was completed by School District. Director stated that not all water outlets used for drinking and food preparation purposes in the Montessori Way classrooms and outdoor areas were tested. LPA informed Director that all water outlets used for drinking and food preparation need to be tested. LPA provided Director with a copy of PIN 21-21.2-CCP.
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Type B
07/05/2024
Section Cited
CCR101220(a)

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(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:
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Director will obtain Physician's Report for two children and submit proof to LPA by plan of correction date of 07/05/2024.
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Based on record reviews, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. Two children, C4 and c8 are missing the Physician's Report.
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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: 06/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2024


LIC809 (FAS) - (06/04)
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