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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416367
Report Date: 08/03/2023
Date Signed: 08/03/2023 12:00:17 PM

Document Has Been Signed on 08/03/2023 12:00 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:OVER THE RAINBOW MONTESSORIFACILITY NUMBER:
434416367
ADMINISTRATOR:VARSHA DEODIKARFACILITY TYPE:
850
ADDRESS:880 HILLSDALE AVENUETELEPHONE:
(408) 691-7621
CITY:SAN JOSESTATE: CAZIP CODE:
95136
CAPACITY: 38TOTAL ENROLLED CHILDREN: 34CENSUS: 27DATE:
08/03/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Varsha DeodikarTIME COMPLETED:
12:30 PM
NARRATIVE
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Licensing Program Analyst (LPA), Janette Cruz, met with Varsha Deodikar, Director, for an unannounced case management inspection. During today's inspection LPA reviewed staff files and observed that none of the staff obtained current Pediatric CPR and First Aid Training Certificate.

A deficiency was cited and appeal rights also given. See (809-D). Exit interview conducted and report was reviewed with Varsha Deodikar, Director.

A notice of site visit was given and must remain posted for 30 days
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE: DATE: 08/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/03/2023
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 2
Document Has Been Signed on 08/03/2023 12:00 PM - It Cannot Be Edited


Created By: Janette Cruz On 08/03/2023 at 11:34 AM
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: OVER THE RAINBOW MONTESSORI
FACILITY NUMBER: 434416367

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/31/2023
Section Cited
CCR
101216(f)

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101216 Personnel Requirements
(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities. This requirement was not met as evidenced by:
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Licensee will submit to LPA Cruz by POC due date a pediatric cardiopulmonary resuscitation and pediatric first aid certificate of qualified staff/teachers currently employed in the facility
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Based on observation, interview and record review, Licensee did not comply with section cited above. LPA observed that none of the staff obtained current Pediatric CPR and First Aid Training Certificate. which poses a potential health, safety or personal rights risk to persons 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:Diana Stephenson
LICENSING EVALUATOR NAME:Janette Cruz
LICENSING EVALUATOR SIGNATURE:
DATE: 08/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/03/2023


LIC809 (FAS) - (06/04)
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