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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413036
Report Date: 12/04/2023
Date Signed: 12/04/2023 12:20:09 PM

Document Has Been Signed on 12/04/2023 12:20 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:GLOBAL VILLAGE MONTESSORIFACILITY NUMBER:
434413036
ADMINISTRATOR:SUSHMA SHRESTHAFACILITY TYPE:
850
ADDRESS:1146 JACKLIN ROADTELEPHONE:
(408) 956-8711
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 16DATE:
12/04/2023
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH: Director Jennifer KarnsouvongTIME COMPLETED:
12:45 PM
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On Monday, December 4, 2023 at 9 am, Licensing Program Analyst (LPA) Manel Estoesta conducted an Unannounced Visit. LPA met with new Director Jennifer Karnsouvong and explained the nature of the site visit. Present on this visit were 6 Staff and 16 Preschool Children. The facility operates from Monday to Friday, 7:30 am to 6 pm.

LPA toured the facility to conduct a Health and Safety Inspection. The Facility has three active licensed rooms which are the Penguin Room, Dolphin Room and Turtle Room. The facility has an outdoor activity space and for electronic sign in/out waiver which was observed to be posted together with the Facility’s License, Parents’ Rights Poster, Personal Rights, Menu and Activity Schedules. Facility was observed to follow teacher to children ratio requirement. Children were engaged in various activities under the visual supervision of the teachers.

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.

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: 12/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/04/2023
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: GLOBAL VILLAGE MONTESSORI
FACILITY NUMBER: 434413036
VISIT DATE: 12/04/2023
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Food and beverages were kept protected against contamination and spoilage. Children's lunches and water bottles are brought from home. 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. LPA observed Smoke and Carbon Monoxide Detectors, fire pull stations, fire extinguishers and sprinkler system. The facility conducts Fire and Disaster Drill monthly. Facility does not provide transportation for children, but Director understands that children cannot be left alone, unattended in park vehicles.

Facility files were reviewed. Children sign in and out procedures and logs were reviewed. Facility is currently using an electronic sign in and out system. and LPA reviewed the system's operation/logging. LPA observed daily attendance completion in each room. A sampling of Children's files was taken for review. The records reviewed include Admission Agreement, Identification and Emergency Information, Medical Assessment, LIC 9224 and Immunization. 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 the Director that AB 1207 Child Care Providers training online at https://mandatedreporterca.com/ requires 2-year requirement. LPA reviewed Staff Immunization records of Measles and Pertussis immunization, Influenza vaccination and TB clearance. LPA reminded Facility Representative that only the Influenza vaccination can be decline with a written declination. LPA obtained copies of the Children's and Staff Sign in and Out, LIC 500 and Facility's Children's Roster.

Director stated that facility does handle medications and does not currently 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.

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: 12/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023
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: GLOBAL VILLAGE MONTESSORI
FACILITY NUMBER: 434413036
VISIT DATE: 12/04/2023
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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.

This report includes Technical Violation. There were no citations on this visit.

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



Exit interview conducted and report was reviewed with the Facility Representative, Director Jennifer Karnsouvong.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023
LIC809 (FAS) - (06/04)
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