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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434404906
Report Date: 03/03/2025
Date Signed: 03/04/2025 09:06:49 AM

Document Has Been Signed on 03/04/2025 09:06 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:APPLESEED MONTESSORI SCHOOLFACILITY NUMBER:
434404906
ADMINISTRATOR/
DIRECTOR:		VENTER, MICHAELLAFACILITY TYPE:
850
ADDRESS:1302 WARNER AVENUETELEPHONE:
(408) 245-7338
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY: 96TOTAL ENROLLED CHILDREN: 54CENSUS: 43DATE:
03/03/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:43 AM
MET WITH:Alson HsuTIME VISIT/
INSPECTION COMPLETED:
03:25 PM
NARRATIVE
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Licensing Program Analyst(LPA), Mandeep Kaur and met with Director, Alson Hsu, for an unannounced-Annual/Random Inspection The purpose of today's inspection was explained with Director.Facility's License, Notification of Parents’ Right Poster, Child Car Seat Law, Personal Rights (LIC 613A), Emergency Disaster Plan, Menus, Activity Schedule, and Earthquake Preparedness Checklist were observed to be posted. The center's operating hours are Monday through Friday from 07:30 AM to 6:00 PM. The facility is licensed to serve children ages 18 months to entry into first grade in Toddler Room# 4B, Preschool rooms: #1,#2, and #3.

LPA toured the indoor and outdoor areas. LPA observed that the teacher-child ratio was in compliance. Fire
drill was conducted on October 17, 2024. The facility has current children's roster and a copy was provided to LPA during the inspection. Cleaning products, disinfectants, sharp objects were stored inaccessible to
children. Furniture and equipment were observed to be age appropriate and in good condition. The facility is
clean. The bathrooms for children and staff are clean, sanitary, and operable. LPA observed 7 toilets and 11 sinks available for the children. Director stated that the center has a third party cleaning service that comes and clean the facility after daycare hours.

The center provides morning snacks, afternoon snacks to the children and lunch is brought from home. Director was reminded of labeling the food container and sippy cups those are brought from home with each child's name on it. There is a kitchen at the facility for food preparation. The kitchen is equipped with refrigerators, stove, oven, microwave, dishwasher, storage space for food, and a sink with hot and cold running water. LPA observed frozen Orange Juice 100% concentrated in the kitchen. Director stated that the facility serve this concentrated juice o children. Drinking water is available for the children indoor via sippy cups and filtered jars. LPA observed trash cans with tight fitting covers for the disposable of solid waste.

Healthy Beverages requirements were discussed and copy is provided to the Director.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 03/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/03/2025
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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Document Has Been Signed on 03/04/2025 09:06 AM - It Cannot Be Edited


Created By: Mandeep Kaur On 03/03/2025 at 02:05 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: APPLESEED MONTESSORI SCHOOL
FACILITY NUMBER: 434404906

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/03/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101429(a)(2)(B)
Responsibility for Providing Care and Supervision for Infants
(B) Staff shall physically check on sleeping infant(s) every 15 minutes and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interviews and record review, the licensee did not comply with the section cited above. Director self admitted that there is no infant sleep log for 15 minutes check up is available for the infants, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/17/2025
Plan of Correction
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By plan of correction due date, 03/17/2025, Licensee will submit the copy of the infant sleep log for 15 minutes check up for any infant who is under two years old to the department.
Type B
Section Cited
HSC
1596.808(a)(2)
Beverages served by daycare providers to children: (a) Commencing January 1, 2012, except as provided in subdivisions (b) and (c), a licensed child day care facility shall comply with all of the following requirements for beverages served by the day care provider to children in the provider’s care: (2) Limit juice to not more than one serving per day of 100-percent juice.


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations and interview, the licensee did not comply with the section cited above. Director stated that facility serves 100% Frozen Concentrated Orange juice to children, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/10/2025
Plan of Correction
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By plan of correction due date, 03/10/2025, Licensee will submit the written statement of understanding of healthy beverages requirements of the 100% juice served to children with the future plan of serving 100% juice served to children at the facility with the correct serving and proof of 100% juice bought for the children to the department.
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:Belinda Devall
LICENSING EVALUATOR NAME:Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:
DATE: 03/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/03/2025


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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: APPLESEED MONTESSORI SCHOOL
FACILITY NUMBER: 434404906
VISIT DATE: 03/03/2025
NARRATIVE
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The facility has fire extinguishers and working smoke and carbon monoxide detectors.

The playground is surrounded with appropriate fencing and the outdoor surfaces are safe. Shade is provided. Drinking water is readily available for the children outdoor via sippy cups and filtered jars. LPA observed climbing structures with resilient material under and around the structures. There were no bodies of water observed. Director stated that there are no weapons or firearms on the premises.

LPA reviewed 6 random children's files. Children records reviewed include Admission Agreement,
Identification and Emergency Information, Consent for Emergency Medical Treatment, Physician's Report, TB test, Immunizations, Parent Right's Receipt, Personal Rights, and Health History.

LPA reviewed 5 staff files. Staff records reviewed include Employee Rights, Statement Acknowledging
Requirement to Report Child Abuse, Health Screening Report with TB Clearance, Immunizations (Measles,
Pertussis, and Influenza) and required training. LPA reminded Assistant Director that the Mandated Reporter Training shall be renewed by all staff every two years. At least one staff member present during the inspection has current Pediatric CPR/First Aid certifications.

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 Sections 101173 and
101226. 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/resources/child-care-centers/.

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.
Continuation on next page
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2025
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: APPLESEED MONTESSORI SCHOOL
FACILITY NUMBER: 434404906
VISIT DATE: 03/03/2025
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LPA discussed the safe sleep regulations with Site 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 Site 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.

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.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP).

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

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&R's) throughout California.

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.

As a result of this inspection, two Type B deficiencies were cited on the attached 809-D.

Exit interview conducted and report was reviewed with Director, Alson Hsu.Appeal rights provided.
A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2025
LIC809 (FAS) - (06/04)
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