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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416981
Report Date: 06/07/2023
Date Signed: 06/07/2023 02:24:32 PM

Document Has Been Signed on 06/07/2023 02:24 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:PIEDMONT HILLS MONTESSORI ACADEMYFACILITY NUMBER:
434416981
ADMINISTRATOR:KIANA DIFRANCESCOFACILITY TYPE:
850
ADDRESS:1425 OLD PIEDMONT ROADTELEPHONE:
(408) 923-5151
CITY:SAN JOSESTATE: CAZIP CODE:
95132
CAPACITY: 65TOTAL ENROLLED CHILDREN: 63CENSUS: 49DATE:
06/07/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Juan "Joanne" WuTIME COMPLETED:
02:35 PM
NARRATIVE
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Licensing Program Analyst (LPA) Kassandra Medrano conducted a Case Management inspection today. LPA met with Joanne Wu, Head of Schools and Licensee. The purpose of the visit was explained. During todays inspection LPA conducted 3 staff interviews, when LPA requested the 4th staff member Joanne entered and LPA heard echoes of what was being said in room where interviews were being conducted over what sounded like a speaker. LPA then asked Joanne if she had been listening to interviews, Joanne stated she had been listening into private interviews over her phone through the camera in the room.

Exit interview conducted and report was reviewed with the Licensee, Joanne Wu.

California Code of Regulations, Title 22 deficiencies are being cited on the following page(s):

"NOTICE OF SITE VISIT" DOCUMENT WAS POSTED ADJACENT TO THE MAIN ENTRY DOORWAY AND VISIBLE TO PARENTS. LICENSEE MUST POST ANY TYPE A DEFICIENCIES DURING TODAYS VISIT WITH THE NOTICE AND LICENSEE UNDERSTANDS THE NOTICE AND TYPE A DEFICIENCIES MUST REMAIN POSTED FOR THIRTY DAYS. REQUIREMENTS FOR AB 633 FACT SHEET AND A COPY OF ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC 9224) WERE DISCUSSED WITH APPLICANT/PROVIDER. PROVIDER UNDERSTANDS THIS REQUIREMENT.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE: DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2023
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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Document Has Been Signed on 06/07/2023 02:24 PM - It Cannot Be Edited


Created By: Kassandra Medrano On 06/07/2023 at 12:56 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: PIEDMONT HILLS MONTESSORI ACADEMY
FACILITY NUMBER: 434416981

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/08/2023
Section Cited
CCR
101200(b)(1)

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101200(b)(1) Inspection Authority of The Department
(b) The Department has the authority to interview children or staff without prior consent.(1) The licensee shall ensure that provisions are made for private interviews with any children or staff members.
The requirement was not met as evidenced by:
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Licensee stated that she is now aware of this requirement, and will send a written statement acknowledging the requirement.
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Based on observation and interview, with head of schools, licensee, joanne wu. It was observed at 11:49am Joanne came into the directors office and had been listening into room as staff interviews were being conducted This poses an immediate risk to children 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:Kassandra Medrano
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2023


LIC809 (FAS) - (06/04)
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