191604893-9-22-2023-30-CC-JLAO-CVWM48-20230922091615

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191604893
Report Date: 09/20/2023
Date Signed: 09/22/2023 09:16:32 AM

Document Has Been Signed on 09/22/2023 09:16 AM - 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	PACIFICA MONTESSORI INC.		FACILITY NUMBER:	191604893
ADMINISTRATOR:	STEPHEN CALL		FACILITY TYPE:	850
ADDRESS:	6585 GREEN VALLEY CIRCLE		TELEPHONE:	(310) 417-3087
CITY:	CULVER CITY	STATE: CA	ZIP CODE:	90230
CAPACITY:	72	CENSUS: 30	DATE:	09/20/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Stephen Call, Director		TIME COMPLETED:	12:00 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 9/20/2023 Licensing Program Analyst (LPA) Judy Laureano conducted an unannounced Annual Required Inspection at Pacifica Montessori Inc. located at 6585 Green Valley Circle, Culver City, CA 90230. LPA was greeted by Stephen Call, Facility Director. LPA toured the facility both indoors and outdoors and observed the following: Classroom 1 : 2 staff members and 10 children in care Classroom 2: 2 staff members and 8 children in care Classroom 3: 2 staff members and 12 children in care Facility operates Monday through Friday 8:00 a.m. to 6:00 p.m. Facility serves children ages 2.6 years old through 5 years old. Facility is located in the Heather Village grounds. There are no firearms or ammunition allowed or stored on the premises. No poisons were observed during today’s inspection. Medication is stored in the designated classroom cabinet, inaccessible to the children in care. LPA reminded facility to ensure all medication and documentation is current. Facility contracts with a custodial company, Jam Pro, who clean and disinfects after hours. Disinfectants and cleaning solutions were observed to be stored in kitchen locked cabinet, area has been designated as OFF LIMITS to the children in care. Furniture and equipment are in good condition, free of sharp, loose or pointed parts. Playground equipment is in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. Areas around high climbing equipment have cushioning materials to observed falls. LPA observed wood chips around the play structure in the preschool yard.

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023

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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: PACIFICA MONTESSORI INC.	FACILITY NUMBER: 191604893
	VISIT DATE: 09/20/2023

NARRATIVE

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All toilets and hand washing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe. Solid waste storage containers have tight-fitting covers and are in good repair. Children’s bathrooms were observed and inspected.

All kitchen, food preparation and storage areas are clean, free of litter/rubbish and free of rodents/vermin. Facility provides AM/PM snack; menu is emailed to families. LPA reminded director to ensure menu is posted and available for families to view. Copies of the menus as served shall be dated and kept on file for at least 30 days. Drinking water is available both indoors and outdoors via brita filters observed in each classroom. Children bring in their own refillable water bottles and teachers are responsible for refilling water bottles. Water cups are available when children forget to bring their water bottles.

The facility is free of flies, insects and rodents. Facility contracts with a Pest control vendor to ensure that facility stays pest free. LPA observed working fire extinguishers and working smoke and carbon monoxide detector throughout the facility.

Prior to working or volunteering in a licensed childcare facility, all individuals subject to a criminal record review have received a criminal record clearance or exemption. Upon notification from the Department, the licensee will comply and act immediately to terminate the employment of, remove from the facility or bar from entering the facility for any person it is deemed necessary while the Department considers granting or denying an exemption. Capacity and limitations as specified on the license are being maintained.

At least one person trained in CPR and Pediatric First Aid is present when children are at the facility or at offsite activities. Current CPR and Pediatric First Aid was observed in staff files. LPA discussed the importance of making sure all Pediatric CPR and Pediatric First Aid training is EMSA approved. LPA reviewed 9 staff files and observed all files complete with valid Mandated Reporter Training and proof of immunization. LPA reviewed a sample of children’s files and observed all 6 files were complete. LPA reminded director to ensure all children’s file have all the necessary LIC forms, such as physician’s report. LPA provided updated LIC 311A to facility director and LIC 125 to use as a reference when auditing files. The name of the child care center director or fully-qualified teacher(s) designated to act in the director’s absence has been reported to the Department. The person who signs the child in/out of the facility shall use their full legal signature and record the time of day.

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023

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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: PACIFICA MONTESSORI INC.	FACILITY NUMBER: 191604893
	VISIT DATE: 09/20/2023

NARRATIVE

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Sign in/out sheets were observed by the entrance of the facility. All children are under supervision, including visual supervision, of a teacher at all times. Facility maintains a ratio of one teacher supervising no more than 12 children in care.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for
drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.
For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed on 3/7/2023 in accordance to the Written Directives outlined in PIN 21-21.1-CCP. PIN 22-05-CCP Page Four

LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Facility director, Steven Call, was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility director, Stephen Call.

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023

LIC809 (FAS) - (06/04)

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