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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415853
Report Date: 05/06/2024
Date Signed: 05/07/2024 08:38:44 AM

Document Has Been Signed on 05/07/2024 08:38 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:ALOHA MONTESSORIFACILITY NUMBER:
434415853
ADMINISTRATOR:MARGARET EYERMANFACILITY TYPE:
850
ADDRESS:995 APRICOT AVENUETELEPHONE:
(408) 858-9886
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY: 28TOTAL ENROLLED CHILDREN: 10CENSUS: 7DATE:
05/06/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Magdalena KraintzTIME COMPLETED:
05:10 PM
NARRATIVE
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On 05/06/2024 at 11:55am, Licensing Program Analyst (LPA), Farida Raja, met with Staff, Magdalene (Maggie) Kraintz for an unannounced annual inspection at the facility. The facility is licensed to serve children from 2.5 years to entry into first grade. LPA did not observe Notification of Parents' Rights (PUB 393), Child Passenger Restraint System Poster (PUB 269) and Personal Rights (LIC 613A) posted near the front entrance. Days and hours of operation are Monday through Friday, 7:30 am to 5:30 pm. Staff stated that Director is not on premises today as she is unwell. During staff interview, staff stated that Director is present at the facility once a week and not all hours the facility is in operation. Prior to entry into the facility LPA observed child (C4) washing hands in the outdoor sink without teacher supervision. During the inspection LPA observed children moving into the Sun Room without staff supervision to get their water bottles.

LPA toured the indoor and outdoor areas of the facility during today's inspection and observed 7 children and 2 staff (S1 and S2). Staff S2 left after LPA's arrival. Children were having lunch under the visual supervision of one staff. Classrooms, children's restrooms, staff restroom and kitchen were inspected. Facility has central heating/cooling for comfort of children. Staff states that there are no weapons or firearms on the premises. There is a working telephone at the facility (408-858-9886). Disinfectants, cleaning products, sharp items and medicines were stored inaccessible to the children in care. Medication was observed stored in a backpack in the kitchen.

Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. LPA observed solid waste containers with tight-fitting lids in the kitchen. Nap mats are appropriate. LPA advised staff to place children's bedding so it does not come in contact with one another's. Restrooms and sinks for children were observed to be safe, sanitary, and in working condition. Staff has one separate bathroom that can be utilized by sick children if needed. Sick children are isolated in the reading room and isolation equipment is provided.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE: DATE: 05/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/06/2024
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 9
Document Has Been Signed on 05/07/2024 08:38 AM - It Cannot Be Edited


Created By: Farida Raja On 05/06/2024 at 03:22 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: ALOHA MONTESSORI
FACILITY NUMBER: 434415853

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/06/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101229(a)(1)
Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. Prior to entry into the facility, LPA observed child (C4) washing hands in the outdoor sink without teacher supervision. During the inspection, LPA observed children moving into the Sun Room without staff supervision to get their water bottles. During staff interview, staff stated that after lunch children go by themselves to wash hands and use the restroom.
POC Due Date: 05/07/2024
Plan of Correction
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Director to submit a written plan of correction by POC date of 05/07/2024.
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: 05/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/06/2024


LIC809 (FAS) - (06/04)
Page: 2 of 9
Document Has Been Signed on 05/07/2024 08:38 AM - It Cannot Be Edited


Created By: Farida Raja On 05/06/2024 at 03:22 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: ALOHA MONTESSORI
FACILITY NUMBER: 434415853

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/06/2024

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
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Based on observation and interview, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. During interview, staff stated that water bottles are refilled using store bought gallons of water but kitchen sink is used to wash fruit, vegetables and children's dishes and utensils. Water lead testing has not been completed for this facility.
POC Due Date: 05/20/2024
Plan of Correction
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Director to complete water lead testing for kitchen faucet and submit a plan of correction by POC date of 05/20/2024.
Type B
Section Cited
CCR
101218.1(c)
Admission Procedures and Parental and Authorized Representative's Rights
(c) The licensee shall post the PUB 393 (8/02), Child Care Center Notification of Parents' Rights Poster in a prominent, publicly accessible area in the child care center at all times.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, 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 did not observe Notification of Parents' Rights (PUB 393), Child Passenger Restraint System Poster (PUB 269) and Personal Rights (LIC 613A) posted near the front entrance.
POC Due Date: 05/20/2024
Plan of Correction
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Director to submit a plan of correction by POC date of 05/20/2024.
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: 05/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/06/2024


LIC809 (FAS) - (06/04)
Page: 3 of 9
Document Has Been Signed on 05/07/2024 08:38 AM - It Cannot Be Edited


Created By: Farida Raja On 05/06/2024 at 03:22 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: ALOHA MONTESSORI
FACILITY NUMBER: 434415853

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/06/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101215.1(d)
Child Care Center Director Qualifications and Duties
(d) The child care center director, or the substitute director as specified in (f) below, shall be on the premises during the hours the center is in operation.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, 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 did not observe facility director during today's visit as she is unwell. During staff interview, staff stated that facility director is present once a week at the facility.
POC Due Date: 05/20/2024
Plan of Correction
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Director to submit a plan of correction by POC date of 05/20/2024.
Type B
Section Cited
CCR
101217(a)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:

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 S2 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/20/2024
Plan of Correction
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Director to have staff complete the Personnel Record (LIC 501) and submit proof by plan of correction date of 05/20/2024.
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: 05/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/06/2024


LIC809 (FAS) - (06/04)
Page: 4 of 9
Document Has Been Signed on 05/07/2024 08:38 AM - It Cannot Be Edited


Created By: Farida Raja On 05/06/2024 at 03:22 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: ALOHA MONTESSORI
FACILITY NUMBER: 434415853

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/06/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101220(a)
Child's Medical Assessments
(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services 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 three children, C1, C5 and C6 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/20/2024
Plan of Correction
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Director to obtain children's physician's reports (LIC 701) and submit proof to LPA by plan of correction date of 05/20/2024.
Type B
Section Cited
CCR
101220.1(g)
Immunizations
(g) The licensee shall document each child's immunizations and shall maintain such documentation in the center for as long as the child is enrolled.

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 children, C5 and C6 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/20/2024
Plan of Correction
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Director to obtain children's immunization records and submit proof to LPA by plan of correction date of 05/20/2024.
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: 05/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/06/2024


LIC809 (FAS) - (06/04)
Page: 5 of 9
Document Has Been Signed on 05/07/2024 08:38 AM - It Cannot Be Edited


Created By: Farida Raja On 05/06/2024 at 03:22 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: ALOHA MONTESSORI
FACILITY NUMBER: 434415853

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/06/2024

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 child C6 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/07/2024
Plan of Correction
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Director to obtain written approval and instructions from parent/authorized representative for administration of Epinephrine Autoinjector and submit proof by plan of correction date of 05/07/2024. Director to submit an Incidental Medical Plan for administration of Incidental Medical Services to the Department.
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: 05/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/06/2024


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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: ALOHA MONTESSORI
FACILITY NUMBER: 434415853
VISIT DATE: 05/06/2024
NARRATIVE
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LPA observed fire extinguishers and working smoke and carbon monoxide detectors. Log shows that the last Fire Drill was conducted on 05/01/2024 which is compliant with the six-month requirement for facilities.

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 gallons. Facility provides snack that is prepared in the kitchen and staff stated that the kitchen sink is used to wash fruit, vegetables and children's dishes and utensils. Facility has not conducted water lead testing.

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. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

Facility provides morning and afternoon snack and lunch provided by parents. Menu was observed to be posted near the entrance. Food and beverages were stored safely to prevent contamination and spoilage. Food storage and preparation areas were observed to be sanitary.

LPA observed outdoor play area and equipment during today's inspection. Outdoor area is surrounded by appropriate fencing and the outdoor surfaces are safe. Shade is provided by trees. LPA observed tanbank as resilient material under and around climbing structures and swings. No bodies of water were observed. LPA did not observe sufficient tan bark under the swing set and discussed with staff about obtaining more tan bark and having staff even out tan bark before children go outside. LPA informed Staff that staff need to position themselves so that children are supervised at all times while outdoors.

Children sign in and out logs were reviewed. LPA observed parents/authorized representatives do not use full legal signatures. LPA advised staff to inform parents or child's representatives to sign in and out with full legal signatures as per regulation. Children's roster was reviewed, and a copy was obtained. LPA reviewed seven (7) children’s files during today's inspection. During file review, LPA observed child C1, C5 and C6 are missing the physician's report (LIC 701) and Child C5 and C6 are missing immunization records.

Continued on Page 3
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2024
LIC809 (FAS) - (06/04)
Page: 7 of 9
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: ALOHA MONTESSORI
FACILITY NUMBER: 434415853
VISIT DATE: 05/06/2024
NARRATIVE
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Two (2) staff files were reviewed. All teachers and staff maintain valid background clearances. All staff files reviewed have current CPR and First Aid certification, Mandated Reporter Training and immunization's against measles, pertussis and influenza or a statement declining the vaccine. LPA observed staff S1 and S2 are missing LIC 501 ( Personnel Record).

Staff 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. Facility does not have an approved IMS Plan on file with San Jose Regional Office. During medication review, LPA observed that child C6 does not have a parental consent form for administration of prescription medication. 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. Staff 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

Continued on Page 4
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2024
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: ALOHA MONTESSORI
FACILITY NUMBER: 434415853
VISIT DATE: 05/06/2024
NARRATIVE
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One Type A, seven Type B and two Technical Violations were cited as a result of today's inspection on the attached LIC 809D pages. Appeal rights and LIC 9224 were printed and given to Staff. Due to the issuance of a Type A Citation, 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. LPA reminded Staff that failure to correct deficiencies by Plan of Correction Due Date may result in penalties of $100 per day per violation. Exit interview was conducted with Staff, Magdalena Kraintz.

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: 05/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2024
LIC809 (FAS) - (06/04)
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