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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417130
Report Date: 11/19/2024
Date Signed: 12/18/2024 07:52:57 PM

Document Has Been Signed on 12/18/2024 07:52 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:ASAVARI INC. - VALLEY OAK MONTESSORIFACILITY NUMBER:
434417130
ADMINISTRATOR/
DIRECTOR:		VARSHA KUMARFACILITY TYPE:
850
ADDRESS:4868 SAN FELIPE ROAD, #130,110TELEPHONE:
(408) 250-7408
CITY:SAN JOSESTATE: CAZIP CODE:
95135
CAPACITY: 87TOTAL ENROLLED CHILDREN: 72CENSUS: 63DATE:
11/19/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Varsha KumarTIME VISIT/
INSPECTION COMPLETED:
03:10 PM
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*This report has been amended to reflect the correct age of preschool children the facility is licensed to care for which is 55.
On 11/19/2024 at 11:00am, Licensing Program Analysts (LPAs), Farida Raja and Pedro Solorio-Gutierrez, met with Director, Varsha Kumar, for an unannounced annual/random inspection. The facility is licensed to serve 55 children ages 3-6 years with a toddler component for 32 children, ages 18-36 months in 5 rooms. The facility has two active waivers on file for shared outdoor space between preschool and toddler component children and to have a maximum of 40 children in the outdoor area at any one time. LPAs observed the required posted materials near the entrance. Menus and daily activity schedule were observed to be posted in each classroom. Days and hours of operation are Monday through Friday, 7:30 AM to 6:00 PM.

LPAs and Director toured classrooms and outdoor areas of the facility and observed the following ratios:

Room 1 (Oak)- 15 children : 2 staff


Room 2 (Maple)- 15 children: 2 staff
Room 3 (Willow)- 8 children : 1 staff
Toddler Component - Room 4 (Cherry Blossom)+ Room 5 (Busy Bees)- 5 staff: 25 children

Facility was in compliance with teacher to children ratio requirement. Classrooms, children's restrooms, staff restrooms, kitchen and office area were inspected. Children were engaged in various activities and free play under visual supervision of teachers. Facility has central heating/cooling for comfort of children. Director states that there are no weapons or firearms on the premises. There is a working telephone at the facility. Disinfectants, cleaning products and medicines were stored inaccessible to the children in care. Rooms used for storage were observed to be locked. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. LPAs observed solid waste containers with tight-fitting lids in the rooms. LPAs observed appropriate changing tables that have raised sides and have vinyl changing pads in Rooms 4 and 5.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 11/19/2024 04:29 PM - It Cannot Be Edited


Created By: Farida Raja On 11/19/2024 at 02:29 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: ASAVARI INC. - VALLEY OAK MONTESSORI
FACILITY NUMBER: 434417130

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/19/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101429(a)(2)(C)(3)
Responsibility for Providing Care and Supervision for Infants
(C) Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: (3) Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, the licensee did not comply with the section cited above for children under 2 years of age that are enrolled in the toddler componenet which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/03/2024
Plan of Correction
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Director to complete 15-minute checks for all children under 2 years of age and submit proof to LPA by plan of correction date of 12/03/2024.
Type B
Section Cited
CCR
101226(e)(3)(A)
Health-Related Services
(3) Prescription medications may be administered if all of the following conditions are met: (A) Prescription medications shall be administered in accordance with the label directions as prescribed by the child's physician.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and recrod review, the licensee did not comply with the section cited above for one child, C11 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/03/2024
Plan of Correction
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Director returned the medication to authorized representative during today's inspection. Director to obtain new medication and submit a plan of correction including parental constent to LPA by 12/03/2024.
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:Farida Raja
LICENSING EVALUATOR SIGNATURE:
DATE: 11/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/19/2024


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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: ASAVARI INC. - VALLEY OAK MONTESSORI
FACILITY NUMBER: 434417130
VISIT DATE: 11/19/2024
NARRATIVE
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LPAs observed a trash can with tight fitting cover for the disposal of diapers. Napping mats are appropriate. Restrooms and sinks for children were observed to be safe, sanitary, and in working condition. Staff has one separate bathroom. Sick children will be isolated in the Director's Office or away from the other children and isolation equipment will be provided. Restroom in Room 2 will be used by sick child if needed.

Director stated that medication for children is stored in the office. LPAs observed fire extinguishers, working smoke and carbon monoxide detectors. Log shows that the last Fire Drill was conducted on 09/12/2024 which is compliant with the six-month requirement for facilities.

Drinking water is readily available for children indoors and outdoors via individual water bottles. Water lead testing was completed for the facility on 02/19/2023 and no Action Level Exceedances were reported.



Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. LPA provided Director with the Water Lead Report from the California State Water Resources Control Board during today's inspection.

Facility provides lunch and snacks to the children. Food and beverages were stored safely to prevent contamination and spoilage. Food storage and preparation areas were observed to be sanitary.

LPAs observed that the playground is surrounded by appropriate fencing and the outdoor surfaces are safe. Play equipment is age appropriate and free of hazards. Shade is provided by trees and building overhang. The areas under and around the play structure is cushioned with rubber foam to absorb falls. No bodies of water were observed.

Children sign in and out procedures and logs were reviewed. LPAs reviewed ten (10) children’s files during today's inspection. Each child's file reviewed contained the required forms. Facility was not conducting 15 minute checks for children under 2 years of age. Director stated that she was not aware of the 15- minute check requirement but will complete it going forward.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
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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: ASAVARI INC. - VALLEY OAK MONTESSORI
FACILITY NUMBER: 434417130
VISIT DATE: 11/19/2024
NARRATIVE
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LPAs discussed the safe sleep regulations with Director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Three (3) staff files were reviewed. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. All staff files reviewed contain the required transcripts/verification of experience. At least one staff member on site has a current CPR and First Aid certification. Director understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips). All staff have the required immunization's against pertussis, measles and statement declining influenza. LPAs observed required Mandated Reporter Training on file for all staff.

Director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

This facility provides Incidental Medical Services – IMS. LPAs reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. Facility has an approved IMS Plan on file with San Jose Regional Office. Upon review of medication, LPAs observed one child, C11's medications have expired. LPAs reminded Director to check labels, return any expired medication and obtain new medication and parental consent for children in care.

The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
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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: ASAVARI INC. - VALLEY OAK MONTESSORI
FACILITY NUMBER: 434417130
VISIT DATE: 11/19/2024
NARRATIVE
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Facility does not provide transportation to children, but Director understands that children cannot be left alone, unattended in parked vehicles.

Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Two Type B deficiencies were cited as a result of today's inspection. Exit interview conducted and report was reviewed with Director, Varsha Kumar. Appeals Rights were provided.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
LIC809 (FAS) - (06/04)
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