073402052-6-1-2023-02-CC-CWAS-CSE3DG-20230601180932

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073402052
Report Date: 06/01/2023
Date Signed: 06/01/2023 06:09:37 PM

Document Has Been Signed on 06/01/2023 06:09 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	DANVILLE MONTESSORI SCHOOL		FACILITY NUMBER:	073402052
ADMINISTRATOR:	LABASCO, ELIZABETH		FACILITY TYPE:	850
ADDRESS:	919 CAMINO RAMON		TELEPHONE:	(925) 838-7434
CITY:	DANVILLE	STATE: CA	ZIP CODE:	94526
CAPACITY:	48	CENSUS: 24	DATE:	06/01/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Christopher LaBasco		TIME COMPLETED:	05:00 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 06/01/2023 at 1:00 PM, Licensing Program Analyst (LPA) Christina Watts conducted an unannounced Case Management Inspection for Danville Montessori School. LPA met with Co-Director, Christopher LaBasco and guided analyst on a tour of the facility. LPA explained the purpose of this visit. During today's inspection, there were 24 preschool aged children in care with 5 staff including the Director and 35 children enrolled. Facility hours of operations are Monday - Friday from 7:30 AM - 5:00 PM. Purpose of this visit is to follow up on two self-reported Unusual Incident Report (UIR) that the facility submitted to licensing on 05/30/2023. On 05/22/2023, Multiple interviews stated C3 was outside playing when C1 passed C3 and C1 bite C3 on their arm. S4 stated they did not see the incident but C3 came up to S4 and stated that C1 bit them. S4 stated they show S1 the red mark on C3 and S1 asked C3 what happened. S1 stated that C3 said that C1 bit them. S1 stated they talked to C1 and said to C1 that biting is not nice and we don't bite our friends. S1 stated they had C1 apologize to C3. On 05/25/2023, Multiple interviews stated that C1 was playing on the red truck when C4 came to play on red truck. S2 stated that C4 sat next to C1 and C1 bit C4 on forearm. Multiple interviews stated C4 had a jacket on that day so there was no bite mark on C4's arm. Multiple staff stated they observed salvia on C4's jacket. S2 stated they ask C4 are they okay and C4 stated that they were okay but C1 bit them on their jacket. Director stated during today's inspection that on 05/31/2023, C1 bit C2 on the thigh while in the red truck. Multiple interviews stated that C2 had teeth marks on their thigh area. It was also reported that skin was red as well as broken however there was no blood in the area. S1 stated that C1 was very upset that they bit C2 and sat on the playground. *CON'T ON PAGE 2*

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina Watts	TELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: DANVILLE MONTESSORI SCHOOL	FACILITY NUMBER: 073402052
	VISIT DATE: 06/01/2023

NARRATIVE

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S4 stated that while they were walking and talking with C1 3-4 weeks ago, S4 felt C1's teeth on their right hand. S4 stated they moved their hand and inform C1 that they do use their mouth to bite friends. S4 stated they did not inform parent because they were not injured and that C1 did not really bite S4.

Multiple interviews stated that staff did witness C1 biting or attempt to bite other children or staff. While interviews stated that staff was instructed to shadow C1 while outside after the first incident, C1 was still able to bite 2 more children after the 05/22/2023 biting incident. This is in violation of California Code of Regulations, Title 22.

*SEE LIC 809-D FOR DEFICIENCIES*

LPA Christina Watts informed Director, Christopher LaBasco that this report dated 06/01/2023 documents a Type B citation. Type B citation(s) are a potential risk(s) to the health, safety, or personal rights of children in care.

Exit interview conducted and report was reviewed with the Director, Christopher LaBasco. A notice of site visit was given and must remain posted for 30 consecutive days.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina Watts	TELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/01/2023 06:09 PM - It Cannot Be Edited

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: DANVILLE MONTESSORI SCHOOL	FACILITY NUMBER: 073402052
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/01/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Request Denied Type B 06/16/2023 Section Cited CCR 101223(a)(3)	1 2 3 4 5 6 7	101223 Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights. (3) To be free from...infliction of pain...This requirement has not been met as evidenced by:	1 2 3 4 5 6 7	By COB 06/15/2023, Director will hold staff meeting and discuss children's personal rights. Director will submit to licensing meeting agenda. Director will also submit an written policy on how facility will handle children with behavioral issues.
	8 9 10 11 12 13 14	Based on interviews, the facility did not comply with the section cited above when C1 bite muliplte children and staff which poses an potential risk to the health,safety or personal rights of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Sherelle Johnson	TELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina Watts	TELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023

LIC809 (FAS) - (06/04)

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