434414879-6-18-2025-07-CC-AMOS-DHRUHH-20250618153555

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414879
Report Date: 06/18/2025
Date Signed: 06/18/2025 03:36:17 PM

Document Has Been Signed on 06/18/2025 03:36 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:	CABRILLO MONTESSORI SCHOOL INC		FACILITY NUMBER:	434414879
ADMINISTRATOR/ DIRECTOR:	CINDY PHUNG		FACILITY TYPE:	850
ADDRESS:	2495 CABRILLO AVENUE		TELEPHONE:	(408) 418-3568
CITY:	SANTA CLARA	STATE: CA	ZIP CODE:	95051
CAPACITY: 89	TOTAL ENROLLED CHILDREN: 89	CENSUS: 64	DATE:	06/18/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:30 AM
MET WITH:	Julie Ford/Melissa Wilson Program Director		TIME VISIT/ INSPECTION COMPLETED:	02:45 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	Licensing Program Analyst (LPA)Anna Morales met with Assistant Director Julie Ford for an unannounced Annual Random Year inspection and informed her the purpose of today’s inspection. Melissa Wyant, Program Director arrived shortly after. The facility is licensed to serve children ages 2 years to entry into first grade in four rooms. LPA observed the required posted materials in the facility lobby including monthly menus. Days and hours of operation are Monday through Friday,7:00am to 6:00pm. LPA was notified that there has been a change of Director, and Program Director Melissa Wyant is acting as Director until July 7,2025 when the new Director begins. LPA was informed that the previous Director last day was at the end of May 2025. LPA toured the indoor and outdoor areas of the facility with Assistant Director and observed the following ratios in each classroom: Pinnacles Room- 17 children: 2 teachers, one aide Sequoia Room- 18 children: 2 teachers Denali Room- used for extracurricular activities and to provide afternoon care. Yellowstone Room- 29 children: 3 teachers. Facility was in compliance with teacher to children ratio requirement. Classrooms, children's restrooms, staff restrooms, kitchen, lobby, outdoor including garden area were inspected. During today's inspection, LPA observed children participating in individual and group 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. Disinfectants and cleaning products were stored in high cabinets inaccessible to the children in care. Cabinets used for storage were observed to be child locked. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. Napping mats were appropriate. LPA observed solid waste containers with tight-fitting lids in the rooms.

NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Anna Morales
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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: CABRILLO MONTESSORI SCHOOL INC	FACILITY NUMBER: 434414879
	VISIT DATE: 06/18/2025

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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. Staff has separate bathrooms that can be utilized by sick children if needed. LPA observed fire extinguishers, working smoke and carbon monoxide detectors, and fire pull stations. The facility has a built-in smoke detector/ fire system. Log shows that the last Fire Drill was conducted on May 29,2025, which is compliant with the six-month requirement for facilities.

Drinking water is readily available for children in each room via water dispensers and disposable cups. The water dispensers are refilled using filtered water pitchers. Facility provides drinking water outdoors using water pitchers and disposable cups. Facility is not subject to the Lead Testing requirement as it was constructed after January 1, 2010. LPA referred Director to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Facility provides AM and PM snack and children bring lunch from home. Snacks are stored in the kitchen area and storage areas were observed to be clean. Snack preparation areas in each classroom were observed to be clean. Monthly menu was observed to be posted in each classroom along with a list of children with food allergies or preferences.
Outdoor playground and play equipment was inspected and observed to be fenced in and free of hazards. Play equipment was in good condition, age-appropriate and has rubber flooring under high climbing structures as resilient material to absorb falls. Shaded rest area is provided by trees. There were no bodies of water observed.

Children sign in and out procedures and logs were reviewed. Children's roster was reviewed. LPA reviewed seven (7) random children's files during today's inspection. Each child's file reviewed contained the required forms.
A random sample of five(5) staff records were reviewed and all teachers and staff maintain valid background clearances. 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.

NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Anna Morales
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025

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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CABRILLO MONTESSORI SCHOOL INC	FACILITY NUMBER: 434414879
	VISIT DATE: 06/18/2025

NARRATIVE

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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 and influenza/statement declining the vaccine. LPA also observed the required Mandated Reporter Training on file for all staff.

Director Manager were 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. Medication was observed to be stored in backpacks in each classroom, 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. Staff restroom which is off limits to other children is used if necessary. Child is always under visual supervision while in care of the facility. For IMS information see PIN 22-02-CCP. 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 in parked vehicles unattended at any time, the vehicles used to transport children shall be maintained in safe operating conditions, and all vehicle occupants must be secured in an appropriate restraint system. Director stated that parents volunteer to provide transportation during field trips.
Director r 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.

NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Anna Morales
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025

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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CABRILLO MONTESSORI SCHOOL INC	FACILITY NUMBER: 434414879
	VISIT DATE: 06/18/2025

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

Exit interview conducted and report was reviewed with Assistant Director Julie Ford and Program Director Melissa Wyant.

As a result of today's inspection, A Technical Violation for Reporting Requirements was issued.

Appeal Rights were given.

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

NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Anna Morales
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025

LIC809 (FAS) - (06/04)

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