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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191605026
Report Date: 09/18/2019
Date Signed: 09/18/2019 11:16:20 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:MONTESSORI SCHOOL-EUREKAFACILITY NUMBER:
191605026
ADMINISTRATOR:PIJPAERT, PIETERNELLAFACILITY TYPE:
850
ADDRESS:5306 E. ARBOR RDTELEPHONE:
(562) 421-5505
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY:56CENSUS: 24DATE:
09/18/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:39 AM
MET WITH:Sandra Acuna TIME COMPLETED:
11:30 AM
NARRATIVE
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An unannounced Annual Random Inspection was conducted by Licensing Program Analyst Timothy Fields. LPA met with Lead Teacher Sandra Acuna and was guided on a complete tour of the facility. Licensee/director Pijpaert Pieternella arrived at the conclusion of the tour. Operating hours are 6:30am - 6:30pm, Monday - Friday.

Prescription medication is administered to children in care. Medication was properly labeled and stored in the office. Morning and afternoon snacks are provided by the facility. Children are required to bring lunch from home. Classroom number 2 is used as an isolated area for sick children. First aid kits are located in each classroom. Supplies were inventoried. Sign in/out sheets were reviewed.

Three classrooms are used to operate the preschool program. The music room which doubles as the food preparation area is also in use. Appliances observed is a refrigerator, sink, and microwave. No meals are cooked on-site. LPA observed 15 students supervised by one teacher and one teacher assistant in the music room. No children were in classroom 1 and 2 during the inspection. In classroom #3 LPA observed 11 students supervised by one teacher.

Each classroom was inspected for cleanliness and good repair. LPA observed age appropriate toys and equipment. Napping equipment is stored in classroom #1. Cots were properly stored. Student's individual storage space was inspected. Lunches and water bottles were properly labeled. Lighting was in operable condition. Each classroom has a source of drinking water. Food storage and preparation area was observed to be clean and food was in good quality. Two bathrooms are used by students in care. One urinal in the boys bathroom had a continuous stream of water flowing in the bowl that could become a potential hazard.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Timothy FieldsTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MONTESSORI SCHOOL-EUREKA
FACILITY NUMBER: 191605026
VISIT DATE: 09/18/2019
NARRATIVE
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Outdoor area and equipment was inspected for safety, cushioning material, good repair and age appropriateness. Required shade and fencing were inspected. Play area was inspected for hazards and inaccessibility to bodies of water. Teacher child ratios were observed and staff names recorded.

Staff and children records were reviewed for completeness including but not limited to Criminal Record Clearances for adults, teacher qualifications and verification of CPR/First Aid and health preventive practices documentation. Review of required forms and menus were made.

This facility provides Incidental Medical Services – IMS. 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

After a complete inspection of the facility, the following deficiencies were observed according to California Code of Regulations Title 22 Division 12 during today's visit as indicated on the 809D

  1. One urinal in the boys bathroom had a continuous stream of water flowing in the bowl that could become a potential hazard.

Exit interview conducted with Lead teacher Sandra Acuna. Appeal Rights provided and explained. Notice of Site Visit must be posted for (30) days. Failure to do so may result in a $100.00 civil penalty.

INTERNET ADDRESS: http://www.ccld.ca.gov – To access licensing forms, updates and Title 22.

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Timothy FieldsTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MONTESSORI SCHOOL-EUREKA
FACILITY NUMBER: 191605026
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/23/2019
Section Cited

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Fixtures, Furniture, Equipment and Supplies:
All toilets, handwashing and bathing facilities shall be maintained in safe and sanitary operating condition. Additional equipment, aids and/or conveniences shall be provided as needed in centers that serve children with physical disabilities.
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The requirement is not met as evidenced by One urinal in the boys bathroom had a continuous stream of water flowing in the bowl that could become a potential hazard. This poses a potential risk to the health and safety of children in care.
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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: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Timothy FieldsTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:
DATE: 09/18/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3