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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413552
Report Date: 06/27/2024
Date Signed: 06/28/2024 04:04:00 PM


Document Has Been Signed on 06/28/2024 04:04 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 SCHOOLFACILITY NUMBER:
434413552
ADMINISTRATOR:YI CHENFACILITY TYPE:
850
ADDRESS:3695 ROSE TERRASSE CIRCLETELEPHONE:
(408) 396-1654
CITY:SAN JOSESTATE: CAZIP CODE:
95148
CAPACITY:90CENSUS: 41DATE:
06/27/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:58 AM
MET WITH:Teresa Chen and Barbara LewisTIME COMPLETED:
12:00 PM
NARRATIVE
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On 06/27/2024 at 8:58am, Licensing Program Analyst (LPA), Farida Raja conducted an unannounced case management inspection to follow-up on an incident reported by the facility on 06/18/2024. LPA met with staff, Aysha Douglas and was asked to contact the Director via phone as she was on her way. LPA called Director and informed her of the purpose of today's inspection. Director stated that she and Owner, Teresa Chen will be at the facility shortly. Owner arrived at 9:35am and LPA informed her of the reason for today's inspection.

LPA conducted a facility walk through and observed ratios in three classrooms. Facility is operating within the ratio and capacity requirements of the license.

LPA interviewed 4 staff including director and owner regarding the incident involving two staff, S1 and S2. LPA obtained a copy of the written incident report that Director stated was submitted to the San Jose Regional Office on 06/26/2024. Based on the information obtained through interviews 19 preschool children were present and observed the argument between two staff (S1 and S2). Based on interviews, staff, S2 left the classroom to speak with Director while there were 19 children present leaving the classroom out of ratio.

Director was reminded that all unusual incidents affecting health and safety of children need to be reported to Licensing within regulatory timelines. LPA reminded Director that a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information shall be submitted to the Department within seven days following the occurrence of such event. Based on interviews, incident occurred on 05/09/2024 but was not reported to Child Care Licensing until 06/18/2024.

Director and Owner stated conversations, text messages and meetings were conducted with each staff emphasizing that their behavior was unprofessional and unacceptable. Facility also placed staff S1 on leave pending an internal investigation. As of June 21, 2024 staff S1 is no longer employed by Lighthouse Montessori School.

Continued on Page 2
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida RajaTELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4


Document Has Been Signed on 06/28/2024 04:04 PM - It Cannot Be Edited

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/28/2024
Section Cited
CCR
101216.3(a)

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101216.3 Teacher-Child Ratio (a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance, except as specified in (b) and (c) below.

This requirement is not met as evidenced by:
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Director will submit a Plan of Correction to LPA by 06/28/2024 stating how the facility will maintain ratios at all times and provide proof of staff training to LPA.
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Based on interview with Director and staff, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. On the day of the incident (05/09/2024) staff, S2 left staff, S1 in the room alone with 19 children.
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LIC9224 must be signed by all parents currently enrolled. LIC 9224 and LIC 809 and 809 D must be provided to all future enrollments for the next 12 months and maintained in file.

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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 KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida RajaTELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4


Document Has Been Signed on 06/28/2024 04:04 PM - It Cannot Be Edited

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/11/2024
Section Cited
CCR
101212(d)(1)(C)

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101212 Reporting Requirements (d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. (1) Events reported shall include the following: (C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child. This requirement was not met as evidenced by:
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Director will submit a written Plan of Correction stating understanding of reporting requirements for incident's occuring at the facility to ensure that unusual incidents are reported to Licensing with the required time frame.
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An unusual incident that occurred on 05/09/2024 involving two staff (S1 and S2) arguing in front of children in care was not reported to Licensing within the required time frame. This poses a potential risk to the health, safety, and personal rights to children in care.
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Type B
07/11/2024
Section Cited
CCR101223(a)(2)

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101223 Personal Rights (a) (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
This requirement was not met as evidenced by:

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Director will submit a written plan of correction stating how staff are trained regarding acceptable behavior in the presence of children in care by plan of correction date of 07/11/2024.
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Based on interviews, staff stated that an unusual incident occurred on 05/09/2024 involving two staff (S1 and S2) in which they were arguing in front of children in care. This poses a potential risk to the health, safety, and personal rights to children 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 KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida RajaTELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4


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: 06/27/2024
NARRATIVE
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Type A and Type B deficiencies were cited today on the attached LIC 809D pages. Appeal rights and LIC 9224 were printed and provided to Licensee. Due to the issuance of a Type A Citation during today's inspection, a copy of this Licensing Report must be given to each existing parent by the end of today or next day child is in care, and to any newly enrolled parents/guardians enrolled over the next 12 months from the date of this report. In addition, a copy of the LIC 9224 Acknowledgement of Receipt of Licensing Reports must be signed by each parent and kept in each child's file to confirm receipt of licensing report.

Exit interview conducted and report was reviewed with Owner, Teresa Chen and Director, Barbara Lewis.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida RajaTELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4