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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416981
Report Date: 10/23/2024
Date Signed: 10/24/2024 09:39:34 AM

Document Has Been Signed on 10/24/2024 09:39 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:PIEDMONT HILLS MONTESSORI ACADEMYFACILITY NUMBER:
434416981
ADMINISTRATOR/
DIRECTOR:		CARMEN LARAFACILITY TYPE:
850
ADDRESS:1425 OLD PIEDMONT ROADTELEPHONE:
(408) 923-5151
CITY:SAN JOSESTATE: CAZIP CODE:
95132
CAPACITY: 65TOTAL ENROLLED CHILDREN: 65CENSUS: 44DATE:
10/23/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:35 AM
MET WITH:Lara Carmen/DirectorTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
NARRATIVE
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Licensing Program Analysts(LPA's) Anna Morales and Shine Yu conducted an Case Management Visit. LPA's were greeted by Director Lara Carmen and informed her the purpose for this visit.

On 8/19/24, LPA Morales conducted a Collateral Investigation for Facility Number 434414645, and conducted interviews with the facility's staff. Based on interviews Staff (S1-Juan Wu), who acts as a Center Director some days is also operating a FCCH who operations overlaps with this centers operation hours.

Based on the information obtained a TYPE B citation is being issued at today's visit.

A notice of site visit was given and must remain posted for 30 days.
Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Appeal Rights given


Exit interview was conducted with Director Lara Carmen.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024
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 10/24/2024 09:39 AM - It Cannot Be Edited


Created By: Anna Morales On 10/23/2024 at 11:35 AM
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: 10/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/06/2024
Section Cited
CCR
101215.1(d)(1)

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Child Care Center Directors Qualifications and Duties:(d)the child care center director, or the substitute director as specified in (f) below, shall be on the premises during the hours the center is in operation.
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Director stated that she will submit a plan to ensure that she will abide to the regulation 101215.1(d)(1)by the POC date to CCL.
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(1) The child care center director shall not accept outside employment that interferes with the duties specified in this chapter.
The requirement was not met as evidenced by: Based on interviews and records reviewed, Staff ( S1-Juan Wu), who acts as a Center Director some days is also operating a FCCH whose operations overlaps with this centers operation hours. This poses a potential risk to the health, safety and rights of 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:Gladys Kuizon
LICENSING EVALUATOR NAME:Anna Morales
LICENSING EVALUATOR SIGNATURE:
DATE: 10/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/23/2024


LIC809 (FAS) - (06/04)
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