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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416410
Report Date: 10/01/2021
Date Signed: 10/06/2021 10:19:34 AM

Document Has Been Signed on 10/06/2021 10:19 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:SAN JOSE MONTESSORI, L.L.C.FACILITY NUMBER:
434416410
ADMINISTRATOR:SUSAN FERNANDEZFACILITY TYPE:
850
ADDRESS:979 MERIDIAN AVENUETELEPHONE:
(408) 377-9888
CITY:SAN JOSESTATE: CAZIP CODE:
95126
CAPACITY: 36TOTAL ENROLLED CHILDREN: 48CENSUS: 23DATE:
10/01/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Susan FernandezTIME COMPLETED:
11:50 AM
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Licensing Program Analyst (LPA) Dung Mac conducted an unannounced Required – 1 year annual inspection. LPA met with Susan Fernandez, Site Director, and explained the nature of today's visit. The hours of operation are Monday - Friday, 7:30am - 4:30pm. The preschool program is licensed in Rooms 1 and 2, serving children ages 2 years to entry into first grade.

The required materials were observed to be posted. LPA toured the Facility both inside and outside during today's inspection. LPA observed that the teacher/child ratio was in compliance during today's inspection.

LPA observed that both classrooms are clean. LPA observed all furniture and equipment are in good condition and safe for the children. Medications, disinfectants, cleaning solutions, and other items that are dangerous to children are stored in high cabinets inaccessible to children. LPA observed solid waste containers with tight-fitting lids in each room. LPA observed the basement stair is blocked by a shelf..

Staff and children's bathrooms are clean, sanitary, and operable. There is a separate staff bathroom not utilized by the children which an isolated child can use if needed. Drinking water is readily available for the children indoor and outdoor. Susan states that there are no weapons or firearms on the premises. LPA observed working smoke/carbon monoxide detectors and First Aid supplies in both classrooms. Facility provides snacks. Children bring their own lunch.


Report continued on Page #2
SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Dung Mac
LICENSING EVALUATOR SIGNATURE: DATE: 10/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/01/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SAN JOSE MONTESSORI, L.L.C.
FACILITY NUMBER: 434416410
VISIT DATE: 10/01/2021
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LPA reviewed ten children's and five staff files during today's inspection. Each child's file reviewed contains the Information and Emergency Information form (LIC 700) form. All teacher files reviewed contain the required transcripts/verification of experience. All staff have completed the required Mandated Reporter Training for Child Care Workers and have the required immunization records on file. The director and teachers have current First Aid/CPR certifications on file.

Susan 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). The facility provides Incidental Medical Services - IMS.

Outdoor activity space is enclosed by fencing and is observed to be free of hazards. LPA observed that the outdoor equipment is age appropriate and in good condition. There is sufficient resilient materials in the outdoor playground area. LPA did not observe any bodies of water.

LPA conducted an exit interview with Susan. No deficiencies issued during today's inspection.

A Notice of Site Visit was issued and must remain posted for consecutive days..
SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Dung Mac
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2021
LIC809 (FAS) - (06/04)
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