434413552-10-23-2024-07-CC-FRAA-DABQUL-20241023122854

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434413552
Report Date: 10/22/2024
Date Signed: 10/23/2024 12:29:22 PM

Document Has Been Signed on 10/23/2024 12:29 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/ DIRECTOR:	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: 50	CENSUS: 30	DATE:	10/22/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:56 PM
MET WITH:	Sakshi Dhingra and Teresa 'Yi' Chen		TIME VISIT/ INSPECTION COMPLETED:	04:50 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 10/22/2024 at 12:56pm, Licensing Program Analyst (LPA), Farida Raja, met with Staff, Sakshi Dhingra, for an unannounced annual/random inspection. Director was not present at the facility and LPA was informed that Owner will arrive shortly. The facility is licensed to serve children ages 2 years to entry into first grade in 3 rooms. LPA observed the required posted materials including weekly menus and daily activity schedule. LPA advised Licensee to have all postings at one location in the lobby or near the sign in and out binder in front of each classroom. Days and hours of operation are Monday through Friday, 8:00 AM to 5:45 PM. LPA and Staff toured the indoor and outdoor areas of the facility and observed the following ratios: Room 225+ 226 (Sun Room: 1 teacher and 12 children. Room 202 (Earth Room): 2 teachers and 11 children Room 214 A-B (Ocean Room): 1 teachers and 7 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 observed to be napping during today's inspection. Facility has central heating/cooling for comfort of children. Owner states that there are no weapons or firearms on the premises. There is a working telephone at the facility. Disinfectants, and cleaning products 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. Napping equipment is appropriate. LPA observed solid waste containers with tight-fitting lids in each room. 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 the disposal of diapers in the Ocean Room. Continued on Page 2

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024

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: LIGHTHOUSE MONTESSORI SCHOOL	FACILITY NUMBER: 434413552
	VISIT DATE: 10/22/2024

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LPA observed fire extinguishers and working smoke and carbon monoxide detectors in each classroom. Log shows that the last Fire Drill was conducted on 03/21/2024 which is not compliant with the six-month requirement for facilities. LPA reminded Owner that fire drills needs to be conducted every 6 months and documented.

Drinking water is readily available for children in each room and in the outdoor playground area via individual water bottles, sippie cups and drinking water fountains in each classroom. Water lead testing was completed by the facility and no Action Level Exceedances were reported. 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 outlined in PIN 21-21.1-CCP. LPA provided Owner with the Water Lead Report from the California State Water Resources Control Board during today's inspection. During facility walk through LPA observed drinking water fountains in the hallways and Owner stated that children do not use those and carry individual water bottles to the outdoor play area.

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. Weekly menu was observed to be posted in the lobby and in each classroom.

Outdoor playground and play equipment was inspected and observed to be fenced in and free of hazards. LPA observed two separate play areas, one 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, umbrella 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 and a copy was provided to LPA. LPA reviewed six children's files during today's inspection. Each child's file reviewed contained all required forms.

Continued on Page 3

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024

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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LIGHTHOUSE MONTESSORI SCHOOL	FACILITY NUMBER: 434413552
	VISIT DATE: 10/22/2024

NARRATIVE

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LPA reviewed three 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. Owner 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 and measles. LPA reminded Owner that each staff needs to maintain proof of immunization for influenza or a statement declining the vaccine. Through file review, LPA observed that staff S2's Mandated Reporter Training is expired.

Owner 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 the office area. Facility has an approved IMS Plan on file with San Jose Regional Office. Isolation of sick child was discussed, and Owner stated 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 Owner understands that children cannot be left alone, unattended in parked vehicles.

Owner 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.

Owner/ Licensee will submit an updated Personnel Report (LIC 500) and Emergency Disaster Plan (LIC 610) to LPA by 11/05/2024.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024

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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LIGHTHOUSE MONTESSORI SCHOOL	FACILITY NUMBER: 434413552
	VISIT DATE: 10/22/2024

NARRATIVE

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Two Type B deficiencies were cited today on the attached LIC 809D pages. Appeal rights were printed and provided to Owner. LPA reminded Owner that failure to correct deficiencies by Plan of Correction Due Date may result in civil penalties. Exit interview conducted and report was reviewed with Owner, Teresa 'Yi' Chen.

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: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/23/2024 12:29 PM - It Cannot Be Edited

Created By: Farida Raja On 10/22/2024 at 04:16 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: 10/22/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101174(d)

Disaster and Mass Casualty Plan

(d) Disaster drills shall be conducted at least every six months. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above in which poses a potential health, safety or personal rights risk to persons in care. Log shows that the last Fire Drill was conducted on 03/21/2024 which is not compliant with the six-month requirement for facilities. LPA reminded Owner that fire drills needs to be conducted every 6 months and documented.
	POC Due Date: 11/05/2024
	Plan of Correction
1 2 3 4	Owner to complete and document the fire drill and submit fire drill log and plan of correction to LPA by plan of correction date of 11/05/2024.

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
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above for staff S2 which poses a potential health, safety or personal rights risk to persons in care. Through file review, LPA observed that staff S2's Mandated Reporter Training is expired.
	POC Due Date: 11/05/2024
	Plan of Correction
1 2 3 4	Owner to submit certificate of completed Mandated Reporter training for Staff S2 to LPA by plan of correction date of 11/05/2024.

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: 10/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024

LIC809 (FAS) - (06/04)

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