434414755-5-10-2023-07-CC-PHEZ-CRPRGE-20230510130038

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414755
Report Date: 05/10/2023
Date Signed: 05/10/2023 01:00:44 PM

Document Has Been Signed on 05/10/2023 01:00 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	EVERGREEN MONTESSORI SCHOOL - AR		FACILITY NUMBER:	434414755
ADMINISTRATOR:	PRAKASH, SUNITA		FACILITY TYPE:	850
ADDRESS:	3000 ABORN ROAD		TELEPHONE:	(408) 603-5000
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95135
CAPACITY: 50	TOTAL ENROLLED CHILDREN: 50	CENSUS: 38	DATE:	05/10/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Sneh Ayare		TIME COMPLETED:	01:30 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 08/14/19 Licensing Program Analyst (LPA) Pete Hernandez conducted an unannounced Required 1 Year inspection of Evergreen Montessori - AR Preschool today. LPA met with Director, Sneh Ayare and explained the purpose of today's visit. Facility’s License, Activity Schedules, and Menus were observed to be posted but LPA observed Parents’ Rights Poster PUB393 posted in the facility. Facility's operating days and hours are Monday to Friday 7:30 AM to 6:00 PM in Rooms 1 and 2. There are an active waiver on file for use of electronic system for sign in and out. (However the facility prefers to manually sign children in and out at this time.) The physical plant was inspected. LPA toured the building with the Director. Indoor space: Room 1 (Cypress): 19 children / 3 teachers Room 2 (Juniper): 19 children / 3 teachers Facility was observed to be in compliance with teacher to children ratio requirement during LPAs' inspection. The classrooms, restroom shared between both rooms, kitchen, pantry, storage room, lobby and office area were inspected. Children were engaged in various activities under the visual supervision of the teachers. Disinfectants, cleaning solutions, and other items that are dangerous to the health and safety of children were stored in places inaccessible to them. Cabinets, drawers, and rooms used for storage were locked. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. Restroom for children was observed to be in safe, sanitary, and functioning condition. Floors were clean and free from tripping hazard. Foods and beverages were stored safely. Food storage area were clean, free of litter, rubbish, and rodents/vermin. Continued on Page #2. Report dated 05/10/2023

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: EVERGREEN MONTESSORI SCHOOL - AR	FACILITY NUMBER: 434414755
	VISIT DATE: 05/10/2023

NARRATIVE

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Center serves Lunch, AM, PM snack. Water is readily available via pitchers, disposable cups and child's personal water bottles. Trash cans for solid waste had tight-fitting covers on and were in good repair. Director stated that facility does not possess nor store any weapons on the premises. LPA observed a 3A40BC Fire extinguisher, Smoke and Carbon Monoxide Detectors, fire pull stations, and sprinkler system. Log shows that the last Fire Drill was conducted on 05/10/2023. Facility does not provide transportation for children, but Director understands that children cannot be left alone, unattended in parked vehicles.

Outdoor Space: Outdoor playground was inspected and observed to be safe. The play equipment was maintained in good condition and free of hazards. Areas around and under high climbing equipment and slides were cushioned with material that absorbs falls. There were no bodies of water observed. Drinking water is arranged to be readily available via water fountain to children during outdoor activities.

File Review: Sign in and out procedures and logs were reviewed. A sampling of 10 Children's files and 6 Staff files was taken for review. All child files contained Admission Agreement, Physician's Report, Identification & Emergency Information, Parent Rights, Personal Rights, Consent for Emergency Medical Treatment, Immunizations. All staff had Mandated Reporter Training per AB1207 on file. There was at least one Teacher with current certification in Pediatric CPR and First Aid present at the facility during inspection. Children's Roster was reviewed, and a copy was provided to the LPA.

Director stated that facility does handle medications and currently have children in care who require Incidental Medical Services. Facility has an approved IMS Plan on file in the San Jose Regional Office. LPA reviewed storage of medication and equipment / supplies. Owner agreed to remind parents to send new medications.

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 (US DOJ) 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. Isolation of sick child was discussed, and Director explained that a sick child is brought to the office area to be isolated from other children. An adult restroom is used if necessary. Child is always under visual supervision while being cared for.
Continued on Page #3. Report dated 05/10/2023

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: EVERGREEN MONTESSORI SCHOOL - AR	FACILITY NUMBER: 434414755
	VISIT DATE: 05/10/2023

NARRATIVE

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Beginning January 1, 2019 AB2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPA will send a copy of the “Lead Poisoning Facts Information Flyer” to the facility.

LPA reminded Director of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license, and who come in contact with or provide care and supervision to the children. For an initial violation, civil penalty amounts to $100.00 per person per day with a maximum of $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day with a maximum of $3000.00 per person. LPA also reviewed with Director the violations that would result in an immediate assessment of civil penalty in the amount of $500. Director is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online option to pay Annual License fee, Adoption of new Laws, etc.

Should there ever be issuance of Type A citations today, a copy of the Facility Evaluation Report LIC809 has to be posted on the wall and a copy to be given to all parents of currently and newly enrolled children for next 12 months. In addition, copy of LIC9224 Statement Acknowledging Receipt of Licensing Reports need to be signed and kept in child files.

A deficiency is NOT being cited based on the LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, An exit interview was conducted, with the licensee. A copy of this report was discussed and left with the Licensee, Sneh Ayare, whose signature on this form confirm receipt of these documents.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

LIC809 (FAS) - (06/04)

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