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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417199
Report Date: 02/23/2026
Date Signed: 02/23/2026 03:50:27 PM

Document Has Been Signed on 02/23/2026 03:50 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 - YBFACILITY NUMBER:
434417199
ADMINISTRATOR/
DIRECTOR:		SANDHYA PANCHAGNIFACILITY TYPE:
860
ADDRESS:3403 YERBA BUENA ROAD BLDG DTELEPHONE:
(408) 238-7001
CITY:SAN JOSESTATE: CAZIP CODE:
95135
CAPACITY: 70TOTAL ENROLLED CHILDREN: 63CENSUS: 50DATE:
02/23/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:05 PM
MET WITH:Vijayashree Haveri and Sandhya PanchagniTIME VISIT/
INSPECTION COMPLETED:
03:55 PM
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On 02/23/2026, Licensing Program Analyst (LPA), Farida Raja, conducted an unannounced annual/random inspection and met with Teacher, Vijayashree Haveri. LPA explained the purpose of today's inspection. Per teacher, Director was out for an appointment. Director arrived later during the inspection. Facility is licensed to serve 55 children, ages 2 years to entry into first grade and 15 children, ages 18 to 36 months in three classrooms. LPA observed the required posted materials outside Room 1 (Birch Room) and menus and lesson plans in each classroom. Days and hours of operation are Monday through Friday, 7:30 AM to 6:00 PM. Facility has no active waivers. Director provided LPA with an updated Designation of Facility Responsibility form (LIC 308) during today's inspection.

LPA and Teacher toured the indoor and outdoor areas during today's inspection and observed the following ratios:
Room 1 (Birch)- 3 teachers : 24 children
Room 2 ( Maple)- 3 teachers: 13 children
Room 3 (Willow)- 3 teachers: 13 toddlers

Facility was in compliance with teacher to children ratio requirement. Classrooms, children's restrooms, staff restrooms, kitchen and office area were inspected. Children were observed to be eating lunch. 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 and cleaning products were observed to be stored in high cabinets. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts.

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NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Farida Raja
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 02/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2026
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 5
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: 02/23/2026
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 Indoor and outdoor activity spaces were observed to be properly equipped with age appropriate toys and supplies that are in safe condition. LPA observed a swing-top solid waste container in the Willow room. LPA reminded Director that trash cans used to dispose solid wastes need to have a tight-fitting cover. Trash cans in the other rooms were observed to have tight-fitting covers. LPA observed appropriate changing tables that have raised sides and vinyl changing pads in Rooms 2 and 3 and changing tables within arms reach of a sink. LPA observed a trash can with tight fitting cover for the disposal of diapers. Napping equipment is appropriate. Restrooms and sinks for children were observed to be safe, sanitary, and in working condition. Staff have two separate bathrooms that can be utilized by sick children if needed. Per director, facility is cleaned by staff during the day and every evening by a janitorial service. Facility is also deep cleaned by staff every Friday.

LPA observed fire extinguishers, working smoke and carbon monoxide detectors, and fire pull stations. Log shows that the last Fire Drill was conducted on 02/05/2026 which is compliant with the six-month requirement for facilities.

Drinking water is readily available for children in each room via individual water bottles and water pitcher and disposable cups. 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. Facility was built after January 1, 2010 and is not required to complete the testing.



Facility does provide meals and snacks to the children in care. Parents are allowed to provide meals and snacks as well. Monthly menu was observed to be posted in the kitchen area and in each classroom. Food and beverages were stored safely to prevent contamination and spoilage. Food storage and preparation areas were observed to be sanitary. Food was observed to be delivered to each classroom in covered containers.

Outdoor playgrounds and play equipment was inspected and observed to be fenced in and free of hazards. LPA observed play equipment was in good condition, age-appropriate, and has sufficient resilient material around and under high climbing equipment and slides to absorb falls. LPA observed the resilient rubber flooring in the preschool playground is cracked and broken in some places. LPA advised director that any holes and cracked surfaces need to be fixed as they could pose a tripping hazard.

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NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Farida Raja
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2026
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: 02/23/2026
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 Shaded rest areas are provided by pergola, trees, umbrellas and building overhang. There were no bodies of water observed. Drinking water is available outdoors through individual water bottles, water pitcher and disposable cups. Director stated that children do not use the two drinking water fountains in the outdoor area.

Children sign in and out procedures and logs were reviewed. Children's roster was reviewed, and a copy was provided to the LPA.

A random sample of six children’s files were reviewed. Each child's file contained the required forms including 15 minute sleep check for all infants in care. LPA reminded Director that a Needs and Services Plan needs to be completed for all infants in care and the plan needs to be updated quarterly or as needed.

LPA 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.

Five staff files were reviewed. All teachers and staff maintain valid background clearances. All staff files reviewed contain the required transcripts/verification of experience. Most staff files have 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 influenza/ statement declining the influenza immunization. LPA observed the 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.

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NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Farida Raja
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2026
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: 02/23/2026
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This facility provides Incidental Medical Services – IMS. LPA 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. Any medications at the facility are stored in the office inaccessible to children in care. Isolation of sick child was discussed, and Director explained that sick children will be isolated in the director's office and isolation equipment will be provided. A staff restroom which is off limits to other children is used if necessary. Child is always under visual supervision while in care of the facility.

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/.

Facility does not provide transportation to children. 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.

No deficiencies were cited as a result of today's inspection. Appeal rights provided. Exit interview conducted and report was reviewed with Director, Sandhya Panchagni.

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.

NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Farida Raja
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2026
LIC809 (FAS) - (06/04)
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