434416410-1-17-2023-07-CC-PHEZ-CN6TZ2-20230117140937

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416410
Report Date: 01/17/2023
Date Signed: 01/17/2023 02:11:38 PM

Document Has Been Signed on 01/17/2023 02:11 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	SAN JOSE MONTESSORI, L.L.C.		FACILITY NUMBER:	434416410
ADMINISTRATOR:	SUSAN FERNANDEZ		FACILITY TYPE:	850
ADDRESS:	979 MERIDIAN AVENUE		TELEPHONE:	(408) 377-9888
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95126
CAPACITY: 48	TOTAL ENROLLED CHILDREN: 48	CENSUS: 22	DATE:	01/17/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:50 AM
MET WITH:	Susan Fernandez		TIME COMPLETED:	02:39 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) Pete Hernandez 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 - 4:00pm. The preschool program is licensed in Rooms 1 and 2, serving children ages 2 years to entry into first grade. LPA observed: Room 1: 2 Teachers and 9 Preschoolers. Room 2: 2 Teachers and 13 Preschoolers. LPA observed that the teacher/child ratio was in compliance during today's inspection. The required materials were observed to be posted. LPA toured the Facility both inside and outside during today's inspection. The physical plant was inspected. LPA toured the building with the Director. Indoor space: The classrooms, 2 children's restrooms, 2 staff restrooms and office area were inspected. Director was present during inspection. Facility was in compliance with teacher to children ratio requirement. Children were engaged in various activities under the visual supervision of the teachers. LPA did not observe disinfectants, cleaning solutions or chemicals that are dangerous to the health and safety of children and were inaccessible to the children in care. All other cabinets, drawers, and rooms used for storage were locked. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. Restrooms for children were observed to be in safe, sanitary, and functioning condition. Floors were clean and free from tripping hazards. Foods and beverages were stored safely. Food storage area were clean, free of litter, rubbish, and rodents/vermin. Report continued on Page #2

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2023

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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SAN JOSE MONTESSORI, L.L.C.	FACILITY NUMBER: 434416410
	VISIT DATE: 01/17/2023

NARRATIVE

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Trash cans for solid waste had tight-fitting covers on and were in good repair. Director stated that facility does not possess nor store any weapons on the premises. LPA observed three 3A40BC Fire extinguishers, working Smoke and Carbon Monoxide Detectors, and fire pull stations. Log shows that the last Fire Drill was conducted on 10/28/2022. Facility does not provide transportation for children, but Director understands that children cannot be left alone, unattended in parked vehicles.

Outdoor Space: Outdoor playground was inspected and observed to be safe. The play equipment was maintained in good condition and free of hazards. Areas around and under high climbing equipment and slides were cushioned with material that absorbs falls. There were no bodies of water observed. Drinking water is arranged to be readily available to children during indoor and outdoor activities.

File Review: Children sign in and out procedures and logs were reviewed. A sampling of 10 Children's files and 4 Staff files were taken for review. All children's and staff files were complete with all required documentation. Staff files contained appropriate educational units. There was at least one Teacher with current certification in Pediatric CPR and First Aid present at the facility during inspection. All Teachers and Directors has current CPR and First Aid certificates that expire on 8/16/2023. Children's Roster was reviewed and a copy was provided to the LPA.

Director stated that facility does handle medications and currently has children in care who require Incidental Medical Services. Facility has an approved IMS Plan on file with San Jose Regional Office. LPA reviewed storage of medication and equipment / supplies. Isolation of sick child was discussed, and Director explained that a sick child is brought to the office area to be isolated from other children. A Staff restroom is used and is off limits to other children is located near the office is used if necessary. Child is always under visual supervision while in care of the facility.

Incidental Medical Services (IMS) policy was discussed. Licensee stated that she currently has children in care who requires IMS. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) & link to Commonly Asked Questions and the ADA, available at:<http://www.ada.gov/childqanda.htm> .

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2023

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: SAN JOSE MONTESSORI, L.L.C.	FACILITY NUMBER: 434416410
	VISIT DATE: 01/17/2023

NARRATIVE

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LPA reminded Director of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license, and who come in contact with or provide care and supervision to the children. For an initial violation, civil penalty amounts to $100.00 per person per day with a maximum of $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day with a maximum of $3000.00 per person. LPA also reviewed with Director the violations that would result in an immediate assessment of civil penalty in the amount of $500. Director is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online option to pay Annual License fee, Adoption of new Laws, etc.

Website for provider resources:
http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates
childcareadvocatesprogram@dss.ca.gov

SHOULD there ever be issuance of Type A citations today, a copy of the Facility Evaluation Report LIC809 has to be posted on the wall and a copy to be given to all parents of currently and newly enrolled children for next 12 months. In addition, copy of LIC9224 Statement Acknowledging Receipt of Licensing Reports need to be signed and kept in child files.

A deficiency is NOT being cited based on the LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22. An exit interview was conducted with the Licensee. A copy of this report were discussed and left with the Licensee, Susan Fernandez, whose signature on this form confirm receipt of these documents.

LPA was unable to print a copy of the report on location so one will be e-mailed ASAP.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2023

LIC809 (FAS) - (06/04)

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