444408893-6-9-2023-07-CC-CNEN-CSMV8V-20230609161323

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444408893
Report Date: 06/09/2023
Date Signed: 06/09/2023 04:13:30 PM

Document Has Been Signed on 06/09/2023 04:13 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	QUAIL HOLLOW MONTESSORI		FACILITY NUMBER:	444408893
ADMINISTRATOR:	CYNTHIA LAURIN		FACILITY TYPE:	850
ADDRESS:	187 LAUREL DRIVE		TELEPHONE:	(831) 335-4710
CITY:	FELTON	STATE: CA	ZIP CODE:	95018
CAPACITY:	42	CENSUS: 23	DATE:	06/09/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:13 AM
MET WITH:	Mindy Gillen & Cheryl McGowen		TIME COMPLETED:	04:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA), Cortney Nelson, met with Licensee, Mindy Gillen, for an unannounced Required- 1 Year Inspection. LPA was granted access to the facility by staff member, Natalie, and toured both indoors and outdoors during the inspection. Upon arrival, there were 23 preschool-age children and six staff members present, which is compliant with capacity and ratio requirements. The facility has two year old children in the Sandpiper classroom and all other preschool-age children are in the Pelican classroom. LPA observed all required postings near the entrance to the facility and the hours of operation are Monday – Friday, 7:30AM-5:30PM. The facility completes sign-in/out using the App "Procare" and LPA advised that all digital sign-in/out still require parents to sign with full legal signature. Mindy states that due to connectivity issues, she has discontinued parent signature and LPA advised considering paper signature for parents with use of Procare. The last fire/disaster drill was conducted on 10/2021, which is not compliant with the six-month requirement for facilities. LPA observed two fully charged 3A40BC fire extinguishers (last serviced: 6/2023), functioning smoke detector and carbon monoxide detector. There is a child in care who requires Incidental Medical Services (EpiPen & Inhaler) and the facility is administering medication at this time. LPA observed medication is stored inaccessible to children. There are no weapons or firearms on the premises. 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 Evaluator Manual- Regulation Interpretations and Procedures for Child Care Centers, Section 101173 and 101226. The following information regarding ADA was provided: US Department of Justice 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

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023

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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: QUAIL HOLLOW MONTESSORI	FACILITY NUMBER: 444408893
	VISIT DATE: 06/09/2023

NARRATIVE

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Indoor areas were inspected by the LPA and observed to be clean, orderly, and safe for the day care children. During today's inspection, LPA observed children eating snack, doing Montessori "jobs," and engaging in circle time. There are sufficient age-appropriate materials, toys, and play equipment in the facility. Drinking water is available for children via water dispensers and water bottles from home labeled with the children’s names. Staff and children’s bathrooms are clean, sanitary, and operable. There is a separate staff bathroom, not utilized by the children, which an isolated child can use if necessary. There is a working telephone.

The outdoor area was inspected and observed to be fenced in. LPA observed play equipment was in good condition, age-appropriate, and has sufficient resilient materials (tanbark) to absorb falls. No outdoor bodies of water were observed during today’s inspection. Shaded rest area is provided by building overhang and large trees. There is a properly maintained sandbox, bikes, plastic play houses, garden boxes, and a playground for children to play with.

The facility provides AM/PM snack to children and all food is provided through parent/community donations. Children in care provide their own lunch. The snack menu is in writing and posted at least one week in advance, accessible to authorized representatives. LPA advised adding serving portions to the menu as it currently indicates only portions for parent donation.

Five children’s files were reviewed during today’s inspection and most required documents were present.

Five staff files were reviewed and all required documents were present. There is at least one staff member present with current CPR/First-Aid that expires 4/2024. LPA reminded Mandated Reporter and First-Aid/CPR training should be renewed every two years.

Exit interview conducted and report was reviewed with staff member, Cheryl McGowen.

As a result of today’s inspection, deficiencies were cited, see LIC809-D.

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 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/process.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/09/2023 04:13 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: QUAIL HOLLOW MONTESSORI	FACILITY NUMBER: 444408893
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/09/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101174(d)

Disaster and Mass Casualty Plan

(d) Disaster drills shall be conducted at least every six months. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in as the last disaster drill was conducted 10/29/2021, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/16/2023
	Plan of Correction
1 2 3 4	The facility will conduct a disaster drill by 6/16/2023 and submit proof to the Department.

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above as water lead testing has not been conducted at the facility, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/23/2023
	Plan of Correction
1 2 3 4	The facility will schedule water lead testing and submit required paperwork (facility sketch, LIC9275, LIC9276) upon completion. Proof of scheduled water lead testing to be submitted to the Department by 6/23/2023.

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: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 06/09/2023 04:13 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: QUAIL HOLLOW MONTESSORI	FACILITY NUMBER: 444408893
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/09/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101221(b)

Child's Records

(b) Each record shall contain information including, but not limited to, the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above for one out of five children files reviewed, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/16/2023
	Plan of Correction
1 2 3 4	The Licensee will submit missing paperwork (LIC995, LIC613A, Admission Agreement) by 6/16/2023.

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
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above for child in care with EpiPen without label directions prescribed by the child's physician, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/21/2023
	Plan of Correction
1 2 3 4	The Licensee will obtain physicians note or original packaging for EpiPen that clearly indicates the directions prescribed by the child's physician and submit to the Department by 6/16/2023. Any non-prescription medication given must match dosage on the bottle or a physicians note is required.

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: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023

LIC809 (FAS) - (06/04)

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