434413552-8-30-2023-07-CC-FRAA-CV82AX-20230830171415

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434413552
Report Date: 08/30/2023
Date Signed: 08/30/2023 05:14:29 PM

Document Has Been Signed on 08/30/2023 05:14 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:	LIGHTHOUSE MONTESSORI SCHOOL		FACILITY NUMBER:	434413552
ADMINISTRATOR:	YI CHEN		FACILITY TYPE:	850
ADDRESS:	3695 ROSE TERRASSE CIRCLE		TELEPHONE:	(408) 396-1654
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95148
CAPACITY: 90	TOTAL ENROLLED CHILDREN: 44	CENSUS: 36	DATE:	08/30/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:43 AM
MET WITH:	Barbara Lewis		TIME COMPLETED:	03:00 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	On 08/29/2023 at 9:43am, Licensing Program Analyst (LPA), Farida Raja, met with Director, Barbara Lewis, for an unannounced annual inspection. The facility is licensed to serve children ages 2 years to entry into first grade in 3 rooms. The facility has three waivers on file: (1) to allow sick child to use the same toilet and hand washing fixture as others. Director stated that sick child will be isolated in the office and can now use the bathrooms in the hallway if needed. (2) to have a maximum of 73 children at one time during outdoor play. Director stated that their numbers are lower than 73 and therefore all children can be outdoors at the same time and don't require separate outdoor schedules (3) to share common playground with Heritage Program. Director stated that the Heritage Program is no longer operational. LPA observed the required posted materials including menus and daily activity schedule. Days and hours of operation are Monday through Friday, 8:00 am to 5:45 pm. LPA and Director toured the indoor and outdoor areas on the facility and observed the following ratios: Room 225+ 226 (3-5 years): 2 teachers and 13 children. Room 202 (3-5 years): 1 teacher and 12 children Room 214 A-B (2-3 years): 2 teachers and 11 children Facility was in compliance with teacher to children ratio requirement. Classrooms, children's restrooms, staff restrooms, food preparation area and office area were inspected. Children were engaged in various activities under the visual supervision of teachers. Facility has central heating/cooling for comfort of children. Director states that there are no weapons or firearms on the premises. There is a working telephone at the facility (408-396-1654). Disinfectants, cleaning products, sunscreens and medicines were stored inaccessible to the children in care. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. Floors were clean and free from tripping hazards. Napping equipment is appropriate. LPA observed solid waste containers with tight-fitting lids in the rooms. Restrooms and sinks for children were observed to be safe, sanitary, and in working condition. LPA observed a trash can with tight fitting cover for Continued on Page 2

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

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: LIGHTHOUSE MONTESSORI SCHOOL	FACILITY NUMBER: 434413552
	VISIT DATE: 08/30/2023

NARRATIVE

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the disposal of diapers in Room 214 A-B.

LPA observed fire extinguishers and working smoke and carbon monoxide detectors in each classroom. Log shows that the last Fire Drill was conducted on 04/20/2023 which is compliant with the six-month requirement for facilities. LPA observed an emergency sketch and emergency bag in each classroom with a first aid kit in each emergency bag.

Drinking water is readily available for children in each room and in the outdoor playground area via individual water bottles. Director stated that Water lead testing has not been completed. Director did not have knowledge about the new regulation requiring facilities to get outlets used for drinking water and food preparation tested for lead. LPA referred Director to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Facility provides morning and afternoon snacks. Foods and beverages were stored safely to prevent contamination and spoilage. Food storage and preparation areas were observed to be sanitary. The menu is in writing and accessible to authorized representatives. An allergy list for children in all three classrooms is posted in each classroom.

Outdoor playground and play equipment was inspected and observed to be fenced in and free of hazards. LPA observed two separated play areas and play structures for 2-3 year olds and the other for 3-5 year olds. Play equipment was in good condition and age-appropriate. Areas around and under high climbing equipment and slides were cushioned with resilient rubber material that absorbs falls. Shaded rest area is provided by canopies, umbrellas and play structures. There were no bodies of water observed.

Children sign in and out procedures and logs were reviewed. Children's roster was reviewed. LPA reviewed ten (10) children's files during today's inspection. Each child's file reviewed contained the required forms.

LPA 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 also informed Director of the importance of checking for recalled infant devices

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

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: LIGHTHOUSE MONTESSORI SCHOOL	FACILITY NUMBER: 434413552
	VISIT DATE: 08/30/2023

NARRATIVE

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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.

LPA reviewed six (6) staff files. All staff files reviewed contain the required transcripts/verification of experience. At least one staff member on site has a current CPR and First Aid certification on file. Director 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). All staff have the required Immunization's against Pertussis, Measles an Influenza (or statement declining influenza vaccination). LPA also observed the required Mandated Reporter Training on file for all staff.

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.

This facility provides Incidental Medical Services - IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. Medications at the facility are stored in high cabinets in each classroom. In one classroom, LPA observed child's Epi-Pen left in child's backpack within reach of children. LPA reminded Director that all medications need to be stored out of reach of children. Isolation of sick child was discussed, and Director explained that sick children will be isolated in the director's office and isolation equipment will be provided. 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/.

Facility does not provide transportation to children, but Director understands that children cannot be left alone, unattended in parked vehicles. 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&Rs) throughout California.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

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: LIGHTHOUSE MONTESSORI SCHOOL	FACILITY NUMBER: 434413552
	VISIT DATE: 08/30/2023

NARRATIVE

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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

Two Type B deficiencies were cited today on the attached LIC 809D page. Appeal rights were printed and provided to Director. LPA reminded Director that failure to correct deficiencies by Plan of Correction Due Date may result in penalties of $100 per day per violation.Exit interview conducted and report was reviewed with the Director, Barbara Lewis. Director stated that she will email a copy of current lease to LPA.

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

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/30/2023 05:14 PM - It Cannot Be Edited

Created By: Farida Raja On 08/30/2023 at 02:06 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: LIGHTHOUSE MONTESSORI SCHOOL	FACILITY NUMBER: 434413552
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/30/2023

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 interview and record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. Facility had not completed Water lead testing.
	POC Due Date: 09/13/2023
	Plan of Correction
1 2 3 4	Director will complete Water Lead Testing and send proof of completion to LPA by Plan of Correction date of 09/13/2023. LPA provided Director with a copy of PIN 21-21 CCP.

Type B

Section Cited

CCR

101226(e)(1)(A)

Health-Related Services

(e) In centers where the licensee chooses to handle medications: (1) All prescription and nonprescription medications shall be centrally stored in accordance with the requirements specified below: (A) Medications shall be kept in a safe place inaccessible to children. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. LPA observed child's Epi-Pen left in child's backpack within reach of children in one classroom.
	POC Due Date: 09/13/2023
	Plan of Correction
1 2 3 4	Director will place children's medication out of reach of children and review medication storage procedures with staff. Director will send proof of staff training to LPA by Plan of Correction date of 09/13/2023.

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: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

LIC809 (FAS) - (06/04)

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