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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414163
Report Date: 02/23/2022
Date Signed: 02/23/2022 03:19:18 PM

Document Has Been Signed on 02/23/2022 03:19 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:LITTLE TREE BILINGUAL MONTESSORIFACILITY NUMBER:
434414163
ADMINISTRATOR:Y FEN SHIHFACILITY TYPE:
850
ADDRESS:20111 STEVENS CREEK BLVD.#150&TELEPHONE:
(408) 996-3399
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY: 125TOTAL ENROLLED CHILDREN: 84CENSUS: 76DATE:
02/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Yi Fen ShihTIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Oscar Huang met with Director, Yi Fen Shih for an unannounced annual inspection. LPA explained the nature of today’s inspection to Licensee. LPA also observed 10 staff and 76 preschool day care children in the facility during today's inspection. Days and hours of operation are Monday to Friday, 9:00am to 6:00pm.

Director, Yi Fen Shih was reminded that all adults 18 and over living or working in the facility, 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 licensed Family Child Care Home. 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.

Incidental Medical Services (IMS) policy was discussed. Director, Yi Fen Shih stated that the facility has a IMS plan, but currently there is no children required IMS services. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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

Also after conducting interviewed with director, staff, LPA's own observation and obtained police report in response to an usual incident report submitted to the office on 12/15/2021. LPA concluded that it was unfounded. The facility is in compliance with the regulations.

No deficiency was cited. Exit interview conducted and report was reviewed with Director, Yi Fen Shih. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2022
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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