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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197407586
Report Date: 06/03/2024
Date Signed: 06/03/2024 06:18:17 PM


Document Has Been Signed on 06/03/2024 06:18 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:MONTESSORI OF CHATSWORTHFACILITY NUMBER:
197407586
ADMINISTRATOR:ERBE, ANNEROSEFACILITY TYPE:
850
ADDRESS:10616 ANDORA AVE.TELEPHONE:
(818) 709-2980
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY:110CENSUS: 53DATE:
06/03/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Annerose Erbe, DirectorTIME COMPLETED:
06:15 PM
NARRATIVE
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On 06/03/2024 at 09:00 AM, Licensing Program Analyst (LPA) Elicia Calvillo conducted an unannounced 3 Year Annual Required Inspection. Facility is located at 10616 Andora Avenue, Chatsworth, CA 91311. LPA identified self and met with Annerose Erbe, Title, LPA identified reason for visit and provided Entrance Checklist -Child Care Centers (LIC 125) to help facilitate the inspection.

Facility Representative (FR) Annerose Erbe, Director allowed entry to facility and provided LPA a guided tour of inside and outside of the facility. The facility is currently licensed for a capacity of 110, per FR they currently have XX enrolled. The facility hours of operation are currently Monday thru Friday from 06:30 AM to 05:30 PM.

Required postings were observed posted in lobby and in each classroom.

The facility is made up of two preschool classrooms: Classroom #1 ages 2 years to 3 years and 3 staff present with 16 children. Classroom #7 a large room divided into 4 sections, ages 3 years to 5 years, and 5 staff present with 36 children.



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SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Elicia CalvilloTELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:
DATE: 06/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/03/2024
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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Document Has Been Signed on 06/03/2024 06:18 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: MONTESSORI OF CHATSWORTH
FACILITY NUMBER: 197407586

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/03/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in the mandated reporter certificate was not readily available for Staff #9 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/24/2024
Plan of Correction
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Assistant Director stated that staff listed above will complete Mandated Reporter Training and provide LPA a copy of the certificate by the Plan of Correction due date 06/24/2024,
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in that the Immunization Records were not readily available for Staff #4, Staff #5, Staff #7, and Staff #9 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/24/2024
Plan of Correction
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Assistant Director stated that staff listed above will provide a copy of their Immunization Records and provide LPA a copy by the Plan of Correction due date 06/24/2024,
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: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Elicia CalvilloTELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:
DATE: 06/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/03/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/03/2024 06:18 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: MONTESSORI OF CHATSWORTH
FACILITY NUMBER: 197407586

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/03/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216.1(c)(1)
Teacher Qualifications and Duties
(c) To be a fully qualified teacher, a teacher shall have one of the following: (1) Twelve postsecondary semester or equivalent quarter units in early childhood education or child development completed, with passing grades, at an accredited or approved college or university; and at least six months of work experience in a licensed child care center or comparable group child care program.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in that the staff qualifications were not readily available upon request for Staff #2, Staff #3, Staff #4, Staff #9 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/24/2024
Plan of Correction
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Assistant Director stated that staff listed above will provide transcripts and / or translations of certificates from country of orgin and provide LPA a copy by the Plan of Correction by due date 06/24/2024,
Type B
Section Cited
CCR
101217(a)(12)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (12) Tuberculosis test documents as specified in Section 101216(g).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observatio, interview, and record review, the licensee did not comply with the section cited above in the TB test were not readily available for Staff #9 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/24/2024
Plan of Correction
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Assistant Director stated that staff listed above will provide TB test results and provide LPA a copy by the Plan of Correction due date 06/24/2024,
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: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Elicia CalvilloTELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:
DATE: 06/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/03/2024
LIC809 (FAS) - (06/04)
Page: 3 of 7


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MONTESSORI OF CHATSWORTH
FACILITY NUMBER: 197407586
VISIT DATE: 06/03/2024
NARRATIVE
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Beginning at 09:13 AM AM, LPA observed the following in each classroom. The furniture, toys, and equipment were inspected for age appropriateness and were in good repair. There were cubbies used for each child to store their belongings. There were standard blue cots and bed linens provided by the families and taken home weekly for washing. Drinking water was readily available and sippy cups were identified with each child’s name. The restroom(s) were inspected for safety and sanitation. There were age-appropriate sinks and toilets in classroom #7 and located in the hallway near classroom #1and there was available water, water temperature was appropriate, toilet paper was provided. While inspecting LPA observed that 1 of the toilets in Classroom #7 was not flushing and there were 5 additional toilets. There is telephone service, heating, lighting and ventilation were evaluated for safety and comfort.

LPA observed first aid kits in each classroom and inventoried for necessary supplies. LPA observed a device high on the ceiling per FR it is a carbon monoxide detector. LPA observed smoke detector via fire alarm. Disaster drill log was available. Per FR, isolation area for sick children is in back office and there is an area available to lay down. Hazardous items including poisonous cleaning compounds were stored inaccessible to children. LPAs observed cleaning solutions stored in high cabinets and high shelves in classrooms.

Beginning at 09:17 AM, LPA observed the kitchen area/ food preparation area for safety, cleanliness, and proper equipment. Facility has lunch catered by an outside company, prepares snacks and drinks and snack and lunch menus were reviewed and posted in each classroom. All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair.

Beginning at 10:00 AM, LPA toured the outdoor play area and observed playground equipment in safe conditions, free of sharp, loose, or pointed parts, in good repair and age appropriate. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All areas around or under high climbing equipment, slides, and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard. The children have access to water fountains for drinking water during outdoor play. LPA advised that no children shall be left without the supervision at any time. There is no swimming pool or other bodies of water on the premises. There is small garden in the middle of the play yard and is fences. LPA observed a fountain in the play yard next to the garden, per Director the water source has been removed and LPA observed the fountain was dry with dirt and leaves in the basin.
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SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Elicia CalvilloTELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2024
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MONTESSORI OF CHATSWORTH
FACILITY NUMBER: 197407586
VISIT DATE: 06/03/2024
NARRATIVE
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Beginning at 12:00 PM, staff and children’s records were reviewed for completeness. Inspection of required forms was made and documented on the LIC 857 for children and the LIC 859 for staff. Criminal Record Clearances were reviewed for adults. CPR card expires on 05/17/2026 for Staff #1. Staff files reviewed did have proof of the AB 1207 Mandated Reporter Training certificate on file. Inspection of required forms were discussed.

LPA observed that teacher-child ratios were maintained and staff names were recorded. Care and supervision was evaluated to determine if the basic needs of children are met and appropriate. Sign-in and out sheets and procedures were reviewed. LPA observed 39 of 53 children signed in at time of inspection. Personal Rights of children were observed by LPA.

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 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 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.

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SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Elicia CalvilloTELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2024
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MONTESSORI OF CHATSWORTH
FACILITY NUMBER: 197407586
VISIT DATE: 06/03/2024
NARRATIVE
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CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES
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 in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

LPA discussed the safe sleep regulations with licensee facility representative and
discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and­resources/safe-sleep as an additional resource.

LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Facility Representative 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.


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SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Elicia CalvilloTELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2024
LIC809 (FAS) - (06/04)
Page: 6 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MONTESSORI OF CHATSWORTH
FACILITY NUMBER: 197407586
VISIT DATE: 06/03/2024
NARRATIVE
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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.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are being cited on the attached deficiencies page (LIC 809D).

A Notice of Site Visit was given and must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to comply with posting requirement will result in an immediate civil penalty of $100.00.

Exit interview conducted, appeal rights and report was reviewed with the facility representative, Sabrina Mundel Betancourt, Assistant Director.



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SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Elicia CalvilloTELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2024
LIC809 (FAS) - (06/04)
Page: 7 of 7