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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416974
Report Date: 06/22/2023
Date Signed: 06/22/2023 05:13:33 PM

Document Has Been Signed on 06/22/2023 05:13 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:ORION MONTESSORI SCHOOLFACILITY NUMBER:
434416974
ADMINISTRATOR:SORAYA RAFATFACILITY TYPE:
850
ADDRESS:1055 SOUTH MONROE STREETTELEPHONE:
(408) 881-4853
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY: 69TOTAL ENROLLED CHILDREN: 46CENSUS: 35DATE:
06/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Shriee SrinivasTIME COMPLETED:
05:30 PM
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Licensing Program Analyst (LPA) Marilou Monico met with Owner, Shriee Srinivas, for an unannounced Required - 1 Year Inspection. The purpose of today's visit was explained with Shriee. Facility's License, Notification of Parents’ Right Poster, Child Car Seat Law, Personal Rights (LIC 613A), Emergency Disaster Plan, Menus, Activity Schedule, and Earthquake Preparedness Checklist were observed to be posted. The center's operating hours are Monday through Friday from 07:30 AM to 5:30 PM. The facility is licensed to serve children ages 2 years to 5 years old in Rooms 47, 55, and 57.

LPA toured the indoor and outdoor areas. LPA observed that the teacher-child ratio was in compliance. Fire drill was conducted on June 21, 2023. The facility has current children's roster and copy was provided to LPA during the inspection. Cleaning products, disinfectants, sharp objects were stored inaccessible to children. Furniture and equipment were observed to be age appropriate and in good condition. The facility is clean. The bathrooms for children and staff are clean, sanitary, and operable. Shriee stated that the center has a third party cleaning service that comes before and after daycare hours to clean the facility.

The center provides morning and afternoon dry snacks to children and are prepared in Room 54. Drinking water is available for the children indoor via individual water bottles. LPA observed trash cans with tight fitting covers for the disposable of solid wastes. The facility has fire extinguishers and working smoke and carbon monoxide detectors.

The playgrounds are surrounded with appropriate fencing and the outdoor surfaces are safe. Shades are provided by trees, canopies and building overhang. Drinking water is readily available for the children outdoor via individual water bottles. There is a climbing structure and a swing in Playground 1 with tanbarks as resilient material. There were no bodies of water observed. Shriee stated that there are no we weapons or firearms on the premises.
Continuation on next pages:
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE: DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/22/2023
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ORION MONTESSORI SCHOOL
FACILITY NUMBER: 434416974
VISIT DATE: 06/22/2023
NARRATIVE
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LPA reviewed 10 random children's files. Children records reviewed include Admission Agreement, Identification and Emergency Information, Consent for Emergency Medical Treatment, Physician's Report, TB test, Parent Right's Receipt, Personal Rights, and Health History.

LPA reviewed five (5) staff files. Staff records reviewed include Employee Rights, Statement Acknowledging Requirement to Report Child Abuse, Health Screening Report with TB Clearance, Immunizations (Measles, Pertussis, and Influenza) and required training. LPA observed that five staff (Staff #1 thru #5) are missing proof of current Mandated Reporter Training for Child Care Providers. Staff #3 and #5 are missing health screening report and TB test. LPA reminded Shriee hat the Mandated Reporter Training shall be renewed by all staff every two years. LPA observed that at least one staff member present during the inspection has current Pediatric CPR/First Aid certifications.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/resources/child-care-centers/.

Owner, Shriee, was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

The facility did not complete the lead testing prior to their deadline. LPA referred Owner to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.


Continuation on next page:
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023
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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: ORION MONTESSORI SCHOOL
FACILITY NUMBER: 434416974
VISIT DATE: 06/22/2023
NARRATIVE
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The following items to be sent to Licensing by July 6, 2023:
1) Updated Personnel Report (LIC 500) and Emergency Disaster Plan (LIC 610) together with permission letter from relocation sites.

As a result of this inspection, deficiencies were cited on the following pages:

Exit interview conducted and report was reviewed with Owner, Shriee Srinivas.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023
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Document Has Been Signed on 06/22/2023 05:13 PM - It Cannot Be Edited


Created By: Marilou Monico On 06/22/2023 at 04:38 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: ORION MONTESSORI SCHOOL
FACILITY NUMBER: 434416974

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/22/2023

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 owner's statement and record review, the facility did not complete the lead testing requirement by not having the drinking water and food preparation faucet tested for lead prior to January 1, 2023. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/06/2023
Plan of Correction
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Owner states that she will make an appointment to have the drinking water and food preparation faucet to be tested for lead and will submit proof of appointment by 07/06/23.
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 record review, Staff #1 thru #5 are missing current proof of Mandated Reporter Training for Child Care Providers. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/06/2023
Plan of Correction
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Owner states that she will submit proof that Staff #1 thru #5 completed the Mandated Reporter Training by 07/06/23.
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:Joel Segura
LICENSING EVALUATOR NAME:Marilou Monico
LICENSING EVALUATOR SIGNATURE:
DATE: 06/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/22/2023


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Document Has Been Signed on 06/22/2023 05:13 PM - It Cannot Be Edited


Created By: Marilou Monico On 06/22/2023 at 04:38 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: ORION MONTESSORI SCHOOL
FACILITY NUMBER: 434416974

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/22/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(2)
Personnel Requirements
(2) Each person specified in (g) above shall have a health-screening report signed by the person performing the screening. This report shall indicate the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, Staff #3 and #5 are missing health screening report and TB test. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/06/2023
Plan of Correction
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Owner states that she will send proof of health screening and TB test for Staff #3 and #5 by 07/06/23.
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:Joel Segura
LICENSING EVALUATOR NAME:Marilou Monico
LICENSING EVALUATOR SIGNATURE:
DATE: 06/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/22/2023


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