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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417130
Report Date: 10/16/2024
Date Signed: 10/17/2024 09:03:18 AM

Document Has Been Signed on 10/17/2024 09:03 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-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: 61DATE:
10/16/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:15 PM
MET WITH:Varsha KumarTIME VISIT/
INSPECTION COMPLETED:
05:40 PM
NARRATIVE
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On 10/16/2024 at 4:15pm, Licensing Program Analyst (LPA), Farida Raja conduced an unannounced case management inspection. LPA met with Director, Varsha Kumar and informed her of the purpose of today's inspection.

LPA observed a total of 61 children and 13 staff within the five classrooms toured at the facility. During today's case management inspection LPA reviewed 6 staff files. Through file review, LPA observed staff S1, S3 and S5 are missing proof of immunization's for measles and pertussis, staff, S2, S3, S4 and S5 are missing Personnel Records (LIC 501), staff, S1 is missing the Mandated Reporter Training for childcare workers and staff S3 is missing proof of completion of early childhood education units.

Four (4) Type B deficiencies were cited today on the attached LIC 809D pages. Appeal rights were printed and provided to Director. LPA reminded Director that failure to correct deficiencies by Plan of Correction Due Date may result in civil penalties. Exit interview was conducted with Director, Varsha Kumar.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2024
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 3
Document Has Been Signed on 10/17/2024 09:03 AM - It Cannot Be Edited


Created By: Farida Raja On 10/16/2024 at 04:54 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: 10/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/06/2024
Section Cited
CCR
101416.2(c)(1)

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Infant Care Teacher Qualifications and Duties (c) To be a fully qualified infant care teacher, a teacher shall have the following: (1) Completion, with passing grades, of 12 postsecondary semester or equivalent quarter units in early childhood or child development education at an accredited or approved college or university. This requirement is not met as evidenced by:
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Director to submit proof of completed units including a plan of correction to LPA by plan of correction date of 11/06/2024.
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Through file review LPA observed that staff S3 is missing transcripts that indicate proof of completion of early childhood education units to be a fully qualified teacher. This poses a potential risk to the health, safety and personal rights of children in care.
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Type B
11/06/2024
Section Cited
CCR101217(a)

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Personnel Records (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:
This requirement is not met as evidenced by:
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Director to submit missing documents including a plan of correction to LPA by 11/06/2024.
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Through file review LPA observed that staff, S2, S3, S4 and S5 are missing the required Personnel Record (LIC 501). This poses a potential risk to the health, safety and personal 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:Farida Raja
LICENSING EVALUATOR SIGNATURE:
DATE: 10/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/16/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/17/2024 09:03 AM - It Cannot Be Edited


Created By: Farida Raja On 10/16/2024 at 05:09 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: 10/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/06/2024
Section Cited
HSC
1596.8662(b)(3)

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On and after January 1, 2018, a person who becomes an 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) within the first 90 days that he or she is employed at the facility 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:
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Director to submit proof of completed Mandated Reporter Training for staff S1 including a plan of correction to LPA by 11/06/2024.
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Through file review LPA observed that staff, S1 is missing the Mandated Reporter Training for childcare workers. This poses a potential risk to the health, safety and personal rights of children in care.
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Type B
11/06/2024
Section Cited
HSC1596.7995(a)(1)

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(a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.This requirement is not met as evidenced by:
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Director to submit proof of missing immunizations including a plan of correction to LPA by 11/06/2024.
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Through file review LPA observed that staff S1, S3 and S5 are missing proof of immunization's for measles and pertussis. This poses a potential risk to the health, safety and personal 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:Farida Raja
LICENSING EVALUATOR SIGNATURE:
DATE: 10/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/16/2024


LIC809 (FAS) - (06/04)
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