434408804-9-27-2023-52-CC-MESA-CW3QMY-20230927121820

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434408804
Report Date: 09/27/2023
Date Signed: 09/27/2023 12:18:26 PM

Document Has Been Signed on 09/27/2023 12:18 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	GOLDEN HARVEST MONTESSORI SCHOOL		FACILITY NUMBER:	434408804
ADMINISTRATOR:	KASSIM ALI		FACILITY TYPE:	850
ADDRESS:	1905 NORTH MILPITAS BOULEVARD		TELEPHONE:	(408) 719-1686
CITY:	MILPITAS	STATE: CA	ZIP CODE:	95035
CAPACITY: 80	TOTAL ENROLLED CHILDREN: 80	CENSUS: 38	DATE:	09/27/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:22 AM
MET WITH:	Licensee Kimberly Ali		TIME COMPLETED:	12:00 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	On Wednesday, September 27, 2023 at 10:30 am, Licensing Program Analyst (LPA) Manel Estoesta conducted a required one (1) Year Visit. LPA met with the Licensee Kimberly Ali and explained the nature of the site visit. Present on this visit were 9 staff and 38 preschool children. The facility operates from Monday to Friday 7:30 am to 6:30 pm. LPA toured the facility to conduct a Health and Safety Inspection with the Director and Licensee. 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. The facility is licensed for 5 classrooms. The rooms Junior Adventure and Rocketeer are located next to facility's Main Entrance and adjacent to the fenced front yard facing the street. The rooms Cosmos, Shooting Star and Nebula are located next to the play yard. The classrooms, restrooms, pantry, storage room, and office area were inspected. 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. LPA reminded the Director thatfirearms and other weapons shall not be allowed on or stored on the premises of a child care center. 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: 09/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: GOLDEN HARVEST MONTESSORI SCHOOL	FACILITY NUMBER: 434408804
	VISIT DATE: 09/27/2023

NARRATIVE

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LPA reviewed and or discussed the following;

1. Facility file which Fire and Earthquake Drills were conducted and documented on the month of September 2023. LPA reviewed the facility's Fire Department Inspection Permit that will expire on 12/31/2023.
2. Children’s Sign in and Out Records. LPA also obtained copies of the Facility's updated Personnel Report, and Child Care Facility Roster.
3. Children's Roster attendance checklist in each room.
4. Staff Files. Each file includes Criminal Record and Child Abuse Index Clearance, Health Screening Report with TB Clearance, Education Qualification, records of immunization (Measles and Pertussis), and Training such as the AB1207 Mandated Reporter Certification. There was at least one Teacher with current certification in Pediatric CPR and First Aid present at the facility during inspection.
5. Children Files. Each child’s file contains but not limited to records of receipt for Parents' Rights Notice, Identification and Emergency Information, Consent for Emergency Medical Treatment form, and Immunization.
5. Facility does not provide transportation for children, but the Director understands that children cannot be left alone, unattended in park vehicles.
6. ChildcareExpansionGrantProgram, the Santa Clara County Childcare Resource and Referral (R&R) Program 2023-2024 HEALTH AND SAFETY TRAINING REIMBURSEMENT and FREE training is available to Santa Clara CountyMandated Reporters working at daycare/childcare facilities
7. PIN 23-08-CCP - 2022 Chaptered Legislation Affecting Child Care Facilities

The facility representative stated that facility does handle medications and the facility does not have children in care who requires Incidental Medical Services - IMS Epinephrine and Inhaled Medication. 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/childqanda.htm.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: GOLDEN HARVEST MONTESSORI SCHOOL	FACILITY NUMBER: 434408804
	VISIT DATE: 09/27/2023

NARRATIVE

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Directors were 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.

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.

In the areas that were evaluated, no deficiencies were observed at the time of the visit.

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

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Licensee Kimberly Ali.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

LIC809 (FAS) - (06/04)

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