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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415852
Report Date: 02/28/2024
Date Signed: 02/29/2024 10:22:41 AM

Document Has Been Signed on 02/29/2024 10:22 AM - 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:AMAZING STARS MONTESSORIFACILITY NUMBER:
434415852
ADMINISTRATOR:ANOMA SINGHFACILITY TYPE:
850
ADDRESS:5041 STEVENS CREEK BOULEVARDTELEPHONE:
(510) 364-4430
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY: 36TOTAL ENROLLED CHILDREN: 35CENSUS: 32DATE:
02/28/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
12:41 PM
MET WITH:Anoma SinghTIME COMPLETED:
05:25 PM
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On 02/28/2024 at 12:41pm, Licensing Program Analyst (LPA), Farida Raja, arrived to conduct an unannounced Required-3 Year inspection and met with Teacher, Marlen Espinoza. Director, Anoma Singh arrived at 1pm and LPA informed her of the reason for today's inspection. The facility is licensed to serve children ages 2 years to entry into first grade in four rooms. The facility has one waiver on file to allow preschool and staff to share the bathroom in the primary room at separate times. LPA observed the required posted materials including monthly menus near the entrance. Days and hours of operation are Monday through Friday, 7:45 am to 5:30 pm.

LPA toured the indoor and outdoor areas of the facility and observed the following ratios in each classroom:
Two's Room- 9 children : 1 teacher
Pre Primary Room- 13 children : 1 teacher
Primary Room: 10 children : 1 teacher

There is a working telephone at the facility (408-249-3809). Classrooms, children's restroom, staff restroom, kitchen and outdoor area were inspected. During today's inspection, LPA observed younger children napping and older children engaged in activities under the visual supervision of staff. 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 observed to be stored in high cabinets in the bathroom and kitchen area. Medications are stored in high cabinets in the kitchen area or in refrigerator and are inaccessible to children in care. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. Napping mats are appropriate. LPA observed solid waste containers with tight-fitting lids in the rooms. Restroom and sinks for children were observed to be safe, sanitary, and in working condition.

LPA observed fire extinguishers, working smoke and carbon monoxide detectors, and fire pull stations. Log shows that the last Fire Drill was conducted on 2/20/2024 which is compliant with the six-month requirement for facilities.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE: DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: AMAZING STARS MONTESSORI
FACILITY NUMBER: 434415852
VISIT DATE: 02/28/2024
NARRATIVE
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Drinking water is readily available for children in each room and in the outdoor playground area via individual water bottles which are refilled using store bought water. Written statement from Director informing CCL regarding exclusive use of bottled water for drinking and food preparation purposes is on file. LPA informed Director to submit a labeled facility sketch identifying all water outlets at the facility. 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. Foods and beverages were stored safely to prevent contamination and spoilage. Food storage and preparation areas were observed to be sanitary. All food and beverages that require refrigeration are stored in labeled and covered containers. LPA observed allergy and food preferences posted in the classroom and menu's posted outside the kitchen area.

Outdoor playground and play equipment was inspected and observed to be fenced in and free of hazards. LPA observed play equipment was in good condition, age-appropriate, and has sufficient resilient materials (tan bark) to absorb falls. Areas around and under high climbing equipment and slides were cushioned with tan bark. LPA discussed with Director about plans for obtaining more tan bark and having staff even out tan bark before children go outside. Shaded rest area is provided by canopies and trees. LPA observed a covered sand box in the outdoor area. 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 the LPA. LPA reviewed six (6) children's files during today's inspection. Each child's file reviewed contained the required forms.

A random sample of four (4) staff files were reviewed and all teachers and staff maintain valid background clearances. LPA reviewed transcripts and 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). Two staff (S1 and S3) do not have required immunization's on file. One staff (S4) does not have the required Mandated Reporter training. LPA reminded Director that the Mandated Reporter Training needs to be renewed every two years.

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.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024
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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: AMAZING STARS MONTESSORI
FACILITY NUMBER: 434415852
VISIT DATE: 02/28/2024
NARRATIVE
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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. LPA observed that medication is stored in the kitchen area in high cabinets. LPA observed EpiPen for child (C7) but Director did not have written consent from parent or authorized representative. For IMS information see PIN 22-02-CCP. 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. A 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. 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/.

Director will submit an updated Emergency Disaster Plan (LIC 610) along with permission letters from relocation sites to LPA by 03/13/2024.

Facility does not provide transportation to children. 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.

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

Three (3) Type B deficiencies were cited today on the attached LIC 809D pages. Appeal rights were provided to Director. Exit interview conducted and report was reviewed with Director, Anoma Singh.

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: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024
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Document Has Been Signed on 02/29/2024 10:22 AM - It Cannot Be Edited


Created By: Farida Raja On 02/28/2024 at 04:35 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: AMAZING STARS MONTESSORI
FACILITY NUMBER: 434415852

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/28/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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
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Based on observation, interview and record review, the licensee did not comply with the section cited for one staff (S4) which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/13/2024
Plan of Correction
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Director will have staff (S4) complete the training and submit proof to LPA by Plan of Correction date of 03/13/2024.
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(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:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above for two staff (S1 and S3) which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/13/2024
Plan of Correction
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Director will submit proof of immunizations for measles, pertussis and influenza for staff (S3) and proof of immunization for influenza or statement declining influenza for staff, S1, by plan of coorection date of 03/13/2024.
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: 02/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/29/2024 10:22 AM - It Cannot Be Edited


Created By: Farida Raja On 02/28/2024 at 04:35 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: AMAZING STARS MONTESSORI
FACILITY NUMBER: 434415852

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/28/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101226(e)(3)(B)
Health-Related Services
(3) Prescription medications may be administered if all of the following conditions are met: (B) For each prescription medication, the licensee shall obtain, in writing, approval and instructions from the child's authorized representative for the administration of the medication to the child.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above for one child (C7) which poses a potential health, safety or personal rights risk to persons in care. Director did not obtain written consent from parent or authorized representative to administer EpiPen to child.
POC Due Date: 03/13/2024
Plan of Correction
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Director will obtain written consent to administer medication and submit plan of correction to LPA by 03/13/2024. Director obatined written consent from parent during today's inspection.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: 02/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2024


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