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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700742
Report Date: 08/22/2023
Date Signed: 08/22/2023 11:42:07 AM

Document Has Been Signed on 08/22/2023 11:42 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:GOLDEN HARVEST MONTESSORI SCHOOL-CALAVERAS CAMPUSFACILITY NUMBER:
435700742
ADMINISTRATOR:ALI, KIMBERLY S.FACILITY TYPE:
850
ADDRESS:451 LOS COCHES ROADTELEPHONE:
(510) 468-0060
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 17DATE:
08/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH: Director Kimberly Ali TIME COMPLETED:
11:50 AM
NARRATIVE
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On Tuesday August 22, 2023 at 9:20 AM, Licensing Program Analyst (LPA) Manel Estoesta conducted an unannounced Required 1 Year Visit. LPA met with the Director Kimberly Ali and explained the purpose of today's visit. Present on this visit were 8 staff and 17 preschool children. Facility's operating days and hours are from Monday to Friday 8 AM to 6:00 PM.

LPA toured the facility to conduct a Health and Safety Inspection. Facility’s License, Parents’ Rights Poster, Personal Rights, Activity Schedules and Waivers were observed to be posted. Facility was observed to follow teacher to children ratio requirement during LPAs' inspection. Children were engaged in various activities under the visual supervision of the teachers.

Classrooms 1 - 5 are the licensed rooms. At this time, the classroom that are being used are Daisy, and Sunflower. The classrooms, restrooms, pantry, storage room, and office area were inspected. The Director stated that facility does not possess nor store any weapons on the premises. Disinfectants, cleaning solutions, and other items that are dangerous to children were stored inaccessible to children. Cabinets, drawers, and rooms used for storage were locked. Furniture and equipment such as mats, cots, tables, and chairs were age appropriate and were in good condition, free of sharp, loose, or pointed parts. Restrooms for children's use were observed to be in safe, sanitary, and functioning condition. Floors were clean and free from tripping hazard. There are restroom assigned for the staff to use which is also an Isolation Restroom.

Outdoor activity space is fenced and was inspected. The play equipment was maintained in a safe condition and free of hazards. There were no bodies of water observed. Areas around and under high climbing equipment and slides were cushioned with material that absorbs falls. There were shaded rest areas for children. Drinking water are arranged to be readily available to children during indoor and outdoor activities.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2023
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 08/22/2023 11:42 AM - It Cannot Be Edited


Created By: Manel Estoesta On 08/22/2023 at 10:54 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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: GOLDEN HARVEST MONTESSORI SCHOOL-CALAVERAS CAMPUS
FACILITY NUMBER: 435700742

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/22/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101229.1(b)
Sign In and Sign Out
(b) The person who brings the child to, and removes the child from, the center shall sign the child in/out.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Children Records - Type B: 101229.1(b) - At 9:30 am, LPA observed 17 children present with 6 staff supervision. LPA verified with Staff Fatema that there are 16 children signed in. LPA verified the sign in sheet and 16th child signed in at 9:23 am. This posed a potential health, safety or personal rights risk to persons in care.

POC Due Date: 08/29/2023
Plan of Correction
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The Director will require the parent of the child that did not sign in to complete the sign in and out for today. The Director will submit an updated Sign In and Out policy to the Regional Office via mail and will send a reminder to the parents.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Jason Jang
LICENSING EVALUATOR NAME:Manel Estoesta
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2023


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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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: GOLDEN HARVEST MONTESSORI SCHOOL-CALAVERAS CAMPUS
FACILITY NUMBER: 435700742
VISIT DATE: 08/22/2023
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LPA observed Smoke and Carbon Monoxide Detectors, fire pull stations and fire extinguishers. Facility conducted a Fire and Disaster Drills on 07/27/2023 and 08/09/2023, respectively. Facility does not provide transportation for children, but Director understands that children cannot be left alone, unattended in park vehicles.

Food and beverages were kept protected against contamination and spoilage. Menus were posted. Snack (am and pm) and children's lunches brought from home and or pre-selected through the Facility's food provider for the school year. Food storage area were clean, free of litter, rubbish, and rodents/vermin. Trash cans for solid waste had tight-fitting covers on and were in good repair.

At 9:30 am, LPA observed 17 children present with 6 staff supervision. LPA verified with Staff Fatema that there are 16 children signed in. LPA verified the sign in sheet and 16th child signed in at 9:23 am. This is a potential risk of the health, safety and personal rights of children in care.

Facility files were reviewed. A sampling of Children's files was taken for review. A sampling of Staff's files was taken for review. There was at least one Teacher with current certification in Pediatric CPR and First Aid present at the facility during inspection. LPA reminded Director that only the Influenza vaccination can be decline with a written declination. LPA obtained copies the Facility's Sign In and Out for the day, Enrollment Packet and Facility's Children's Roster

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated 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)/ (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

Facility Representative was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023
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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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: GOLDEN HARVEST MONTESSORI SCHOOL-CALAVERAS CAMPUS
FACILITY NUMBER: 435700742
VISIT DATE: 08/22/2023
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To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director, KImberly Ali.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023
LIC809 (FAS) - (06/04)
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