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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434410834
Report Date: 08/31/2022
Date Signed: 08/31/2022 02:27:37 PM

Document Has Been Signed on 08/31/2022 02:27 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:CRESCENT MONTESSORI SCHOOLFACILITY NUMBER:
434410834
ADMINISTRATOR:JEA SEVILLAFACILITY TYPE:
850
ADDRESS:1651 N. MILPITAS BLVDTELEPHONE:
(408) 263-8170
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY: 108TOTAL ENROLLED CHILDREN: 90CENSUS: 69DATE:
08/31/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Jea SevillaTIME COMPLETED:
02:35 PM
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On August 31, 2022 at approximately 9:30am, Licensing Program Analyst (LPAs) Haderer and Phan arrived unannounced for an annual inspection for compliance to Health and Safety. The new CARE tool was used for the inspection. Present for the inspection was the site director Jea Sevilla; Program Administrator Melissa Wyant, 13 teachers and 69 children in care (toddlers and preschoolers). The facility is in ratio today.

The facility has is a single-story building with 4 preschool classrooms (Cassatt; Monet; O’Keefe and Van Gogh). Each room has dedicated children’s bathrooms with functioning toilets and sinks, and a sink basin in the room with faucets and drinking fountains. There is a enclosed playground area with a large play structure and a sandbox area with ample shade provided in the playground. LPAs observed the playground area is in safe condition and free from sharp, loose or pointed parts and the areas around or under high climbing equipment has appropriate cushioned material that absorbs a fall. Filtered water (Britta) is available for children inside the classrooms and in the playground area. The children are supervised at all times when playing outside.



Off limits to children is the small kitchen area; staff bathrooms; Off limits areas inaccessible by closed and/or locked doors, and/or by child supervision. Sharp objects (knives, scissors) are kept in the off-limits kitchen and out of reach from the children. All disinfectants and cleaning solutions are stored out of the reach of children.

The facility is clean and well organized with ample age appropriate furnishings and equipment. Surfaces including floors and counter tops are clean and toxic free. Hazardous items/toxins are kept out of the access of children. There are no bodies of water accessible to children in care. The facility provides snacks for the children, children bring their own lunch. Milk for the children was organic 2%, however, for children over 2 years of age, only 1% or non-fat may be served. A Technical Violation (not a deficiency) was issued.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2022
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: CRESCENT MONTESSORI SCHOOL
FACILITY NUMBER: 434410834
VISIT DATE: 08/31/2022
NARRATIVE
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The facility has three fully charged 3A40BC fire extinguishers, last tested on 8/22/2022. Carbon monoxide and smoke detectors were available in each classroom, tested and functioning. Fire alarm system tested by RFI Communications & Security Systems on March 1,2022, all passed inspection. Fire drills are conducted once per month, the last drill was conducted 8/5/2022. Heating and ventilation is acceptable.

Sign in/out sheets are done electronically. There was one child present that was not checked in properly see LIC809D for deficiency. All other children present were signed in and accounted for.



Throughout the facility there are trash cans with tight fitting covers for the disposal of solid waste. All required posters are present, License; Parents Rights; Personal Rights; Emergency Disaster Plan; Seatbelt Laws poster. Children’s bathroom has enough towels and soap supplies. The staff have separate adult bathrooms located in the hallway. There are sleeping mats with the crib sheets for napping children. The sheets are washed daily by the facility in the laundry room located inside the facility.

Staff files were reviewed, all records were complete and in good order. All staff subjected to criminal review have been cleared and associated to the facility. All staff are all up to date with CPR/1st Aid certificates and non-expired Mandated Reporter certificates.

Children's records were reviewed: LPA requested and reviewed facility roster, a photo copy was made for the office file. One child’s file was missing the Physician’s Report; the child has been enrolled for more than 30 days, see LIC809D for deficiency.

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/childqanda.htm
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022
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: CRESCENT MONTESSORI SCHOOL
FACILITY NUMBER: 434410834
VISIT DATE: 08/31/2022
NARRATIVE
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Site Director 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.

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.

There were 2 deficiencies issued today, see LIC809D for details. A Technical Violation (not deficiency) was also issued. This report will remain on file for 3 years.

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



Exit interview conducted and report was reviewed with the program administrator Melissa Wyant and Site Director Jea Sevilla.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/31/2022 02:27 PM - It Cannot Be Edited


Created By: Russell Haderer On 08/31/2022 at 01:54 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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: CRESCENT MONTESSORI SCHOOL
FACILITY NUMBER: 434410834

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/31/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101220(a)
Child's Medical Assessments
(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above that one out of 10 children's files was missing the Physician's Report which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/28/2022
Plan of Correction
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Licensee will obtain written medical assessment (Physician's Report) for the child that did not have the record in their file and will ensure all children's files in the future have these reports within 30 calendar days of admission.
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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Based on observation and record review, the licensee did not comply with the section cited above in that one child out of 69 children was in the facility that had not been properly signed in by the parent which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/01/2022
Plan of Correction
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Parents will be more closely monitored to sign in their children upon drop off every day.
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:Chandra Charles
LICENSING EVALUATOR NAME:Russell Haderer
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2022


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