<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416974
Report Date: 05/05/2022
Date Signed: 05/05/2022 02:51:28 PM

Document Has Been Signed on 05/05/2022 02:51 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: 45CENSUS: 45DATE:
05/05/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:12 AM
MET WITH:Sree SrinivasTIME COMPLETED:
03:05 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) Marilou Monico conducted a case management inspection in response to an unusual incident that was self-reported by Owner, Sree Srinivas, to Licensing on May 4, 2022. LPA toured the facility, interviewed staff, reviewed files, and obtained copies of documents.

Based on available evidence and interviews, it was determined that on May 4, 2022, a three-year-old child, (C-1), was found by a middle school student unattended on the curb located outside the gate of Monroe Middle School. This poses an immediate risk to the health, safety, and personal rights of children in care.

Based on record review, Diana Lapustea has been working at the facility without fingerprint clearance.

As a result of this inspection, deficiencies were cited on next page.

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: 05/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/05/2022
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 05/05/2022 02:51 PM - It Cannot Be Edited


Created By: Marilou Monico On 05/05/2022 at 01:16 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: 05/05/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/06/2022
Section Cited
CCR
101229(a)(1)

1
2
3
4
5
6
7
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.
1
2
3
4
5
6
7
Owner, Sree Srinivas, states that she will submit a written plan to ensure that children are provided with adequate supervision at all times. Owner states that she will be scheduling an All Staff Meeting by next week to discuss about supervision, safety and security measures, high security locks, hiring of new staff, and proper positioning of staff, etc.. Meeting agenda and sign in/out sheets to be submitted to Licensing.
8
9
10
11
12
13
14
This requirement was not met as evidenced by: A child was found by a middle school student unattended on the curb located outside the gate of Monroe Middle School. This poses an immediate risk to the health, safety, and personal rights of children in care.
An immediate civil penalty of $500 was assessed.
8
9
10
11
12
13
14
Request Denied
Type A
05/06/2022
Section Cited
CCR101170(e)(1)

1
2
3
4
5
6
7
Criminal Record Clearance - All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:(1)Obtain a California clearance or a criminal record exemption as required by the Department.
1
2
3
4
5
6
7
Owner states that Diana will schedule to get her Livescan fingerprint and can only return to the facility once she obtained fingerprint clearance. Owner states that she will submit written plan of correction by 05/06/22.
8
9
10
11
12
13
14
This requirement is not met as evidenced by:
Diana Lapustea has been working at the facility without fingerprint clearance. This poses an immediate risk to the health, safety, and personal rights of children in care.
A civil penalty of $500.00 was assessed.
8
9
10
11
12
13
14
Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.
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: 05/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/05/2022


LIC809 (FAS) - (06/04)
Page: 2 of 2