434417199-2-20-2025-07-CC-HKAR-DE3RR9-20250220121446

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417199
Report Date: 02/20/2025
Date Signed: 02/20/2025 12:14:55 PM

Document Has Been Signed on 02/20/2025 12:14 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	EVERGREEN MONTESSORI SCHOOL - YB		FACILITY NUMBER:	434417199
ADMINISTRATOR/ DIRECTOR:	SANDHYA PANCHAGNI		FACILITY TYPE:	860
ADDRESS:	3403 YERBA BUENA ROAD BLDG D		TELEPHONE:	(408) 238-7001
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95135
CAPACITY: 70	TOTAL ENROLLED CHILDREN: 70	CENSUS: 41	DATE:	02/20/2025
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:55 AM
MET WITH:	Shveta Shourie		TIME VISIT/ INSPECTION COMPLETED:	12:45 PM

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On 2/20/2025 Licensing Program Analysts (LPAs) Harsimran Kaur and Farida Raja met with Shveta Shourie, Applicant. The purpose of the visit was an announced pre-licensing inspection at the facility to ensure the health, safety and personal rights as required by Title 22 and Health and Safety Regulations governing California Child Care Centers will be met. Applicant requested for a change of ownership for 15 toddlers ages 18 to 36 months in classroom willow RM 3 and 55 preschool children ages 2 to 6 years in classroom Birch RM1 and Maple RM2. The child care center will operate Monday–Friday 7:30AM - 6:00 PM. The fire clearance was approved on 08/06/2024. Facility is operating under existing preschool program #434412148. There are 41 children present during today's inspection.

LPAs toured and measured the on-limits areas and classrooms located at the facility. The facility has a total of 3 classrooms.

Preschool Classroom measurements are:

The Indoor total measurements contain a total of {2081.62} square feet, which will accommodate Applicant’s request for 55 preschool children.

Preschool Outdoor Play measurements are:

Outdoor total measurements contain a total of {4779.17} square feet, which will accommodate Applicant’s request for 55 preschool children.

Toddler Classroom measurements are:

The Indoor total measurements contain a total of {552.37} square feet, which will accommodate Applicant's request for 15 toddler.

Toddler Outdoor Play measurements are:

Outdoor total measurements contain a total of {1426.22} square feet, which will accommodate Applicant’s request for 15 toddler.

SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Harsimran Kaur
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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: EVERGREEN MONTESSORI SCHOOL - YB	FACILITY NUMBER: 434417199
	VISIT DATE: 02/20/2025

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LPAs observed all preschool classrooms to be clean, safe, sanitary and in good repair. A comfortable temperature for children shall be maintained at all times. Furniture and equipment were observed to be maintained in good condition, free of sharp, loose or pointed parts. All materials and surfaces accessible to children, including toys, shall be free of toxic substances. All play equipment and materials used by children were observed to be age-appropriate. There are 66 chairs, 22 tables, 10 sinks, 50 cots, 6 toilets available for preschool and toddler children. LPAs observed individual storage containers for each child in bathroom area. Staff have one separate bathroom that can be utilized by sick children if needed. Sick children will be isolated in the office area of the facility. First aid supplies, medication, and cleaning products are stored in the upper cabinets in the kitchen. LPAs observed containers with tight-fitting lids for the disposal of solid waste and diapers.

LPAs observed fully charged fire extinguisher, smoke and carbon monoxide detectors at the facility. Storage areas for poisons shall be locked. LPAs advised that Applicant maintains first-aid supplies in a location accessible to staff but inaccessible to children. LPAs observed a changing table is within arm’s reach of a sink. Diapering sink is not used for meal preparation or dishwashing.

Applicant was reminded that a child who is between 18 months and 36 months of age may participate in the toddler program with written permission from the child's authorized representative. No child in the toddler program shall be placed in the preschool program before the age of 30 months without written permission from the child's authorized representative.

LPAs observed the facility has a fully fenced outdoor playground with separate areas for toddlers and preschool children. Outdoor area for preschool children were free of hazards including, holes, broken glass dry grasses, and other debris that pose a fire hazard. Any construction or equipment that could pose a hazard in the outdoor activity area shall be made inaccessible to children in care. The areas around and under high climbing equipment, swings, slides and other similar equipment was observed to be cushioned with resilient material that can absorb a fall. The playground is enclosed by a fence to protect children and to keep them in the outdoor activity area. The fence is at least four feet high. Applicant understands that no child(ren) shall be left without visual supervision of a teacher at any time. Outdoor shade was provided by canopy's. LPAs observed no bodies of water.

SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Harsimran Kaur
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

LIC809 (FAS) - (06/04)

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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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: EVERGREEN MONTESSORI SCHOOL - YB	FACILITY NUMBER: 434417199
	VISIT DATE: 02/20/2025

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The facility serves lunch and snacks to the preschool children. Lunch and snacks are prepared off site by vendor Rajjot. LPAs advised Applicant as per Title 22, if food is prepared off the center premises, the following shall apply: (A)The preparation source shall meet all applicable requirements for commercial food services.(B) The center shall have the equipment and staff necessary to receive and serve the food and to clean up.(C) The center shall maintain the equipment necessary for in-house food preparation, or shall have an alternate source for food preparation and service in the event of an emergency. Commercial foods shall be approved by appropriate federal, state and local authorities. All foods shall be selected, transported, stored, prepared and served so as to be free from contamination and spoilage and shall be fit for human consumption.

The Applicants shall take measures to keep the center free of flies, other insects, and rodents. All containers used for storage of solid wastes, including moveable bins, shall have a tight fitting cover that is kept on. LPAs observed no fireplace or open face heaters. Facility provides snacks and lunch for the children. The facility has refrigerator, microwave and cold running water. Drinking water is readily available for the children in the facility.

Drinking water from a non-contaminating fixture or container shall be readily available both indoors and in the outdoor activity area. LPAs advised per Health and Safety Code 1597.16(a)(1) Lead Testing and PIN-21-21-CCP Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010 to test their drinking water for lead contamination between January 1, 2020 and January 1, 2023, and then every 5 years after the date of the first test.

Per Written Directive 100700(c)(1) Written Directives for Lead Testing (1) For a license issued on or after July 1, 2022, initial testing results shall be received and posted within 180 days of licensure.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. 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, available at: http://www.ada.gov/childqanda.htm.

SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Harsimran Kaur
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

LIC809 (FAS) - (06/04)

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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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: EVERGREEN MONTESSORI SCHOOL - YB	FACILITY NUMBER: 434417199
	VISIT DATE: 02/20/2025

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LPAs discussed the safe sleep regulations with Applicant 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. LPAs also informed Applicant 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.

LPAs reviewed with the Applicants LIC 311A, Records to Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

Applicants were informed of the MyChildCarePlan.org site, 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

The following corrections are needed before a licensure will be considered.

1. Proof of preschool playground structure is age appropriate (age sticker)

An exit interview was conducted and copy of appeal rights and this report was provided to the Applicant, Shveta Shourie. Final license determination will be made upon review by the Licensing Program Manager.

SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Harsimran Kaur
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

LIC809 (FAS) - (06/04)

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