197416027-6-12-2024-58-CC-AMOY-D67629-20240612202511

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197416027
Report Date: 06/12/2024
Date Signed: 06/12/2024 08:25:20 PM

Document Has Been Signed on 06/12/2024 08:25 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:	WEST VALLEY MONTESSORI		FACILITY NUMBER:	197416027
ADMINISTRATOR:	JEWEL FERRER		FACILITY TYPE:	830
ADDRESS:	20211 SATICOY STREET		TELEPHONE:	(818) 341-5655
CITY:	WINNETKA	STATE: CA	ZIP CODE:	91306
CAPACITY:	7	CENSUS: 6	DATE:	06/12/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Jewel Ferrer, Director		TIME COMPLETED:	03:45 PM

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Licensing Program Analyst (LPA) Alicia Mooberry conducted an unannounced 3-Year Required Annual Inspection on this date. LPA met with Jewel Ferrer, Director who provided a tour of the facility. LPA provided LIC 125 Entrance checklist. This is an infant program which consists of one classroom. The facility operates Monday – Friday from 7:00 AM – 6:00 PM. The entrance to the facility is locked and parents enter using a call/buzzer system. This facility has Preschool facility #197416028 in the same building. The Infant room and play ground are physically separate from the preschool.

All areas identified on this report were inspected. Upon arrival, LPA observed 6 infants and 3 staff. All staff have obtained background clearance. The facility is observing the ratio during inspection.

LPA observed required posted documentation which included, Facility License, Publication (PUB) 393- Notification of Parent Rights, Licensing Form (LIC) 610- Facility Disaster Plan, PUB 269- Child Passenger Restraint System, and LIC 613A- Notification of Parent’s Rights at the entrance to the building. LPA observed sign in sheets for infants within the same sign in book as the preschool program. All children present were signed in with date, time and signature of child's authorized representative.

Facility records were reviewed for LIC 9040- Facility Roster, 9148- Earthquake Preparedness form, Daily schedule and Disaster drill log. Disaster drill was discussed.

Indoor space is physically separate from the preschool. Furniture and equipment were inspected for age appropriateness and good repair. Toys were observed to be safe, and do not have sharp points, edges, splinters and are not made of small parts that can pose a choking hazard. LPA did not observe any baby walkers or any items that fall into that category present in the facility. LPA observed stuffed animals used by children in care, LPA provided technical assistance regarding providing toys that are easily washable for infants. All materials and surfaces accessible to children are toxic free. Classroom was inspected to ensure that the floors have a surface that is safe and clean. ----------------PAGE 1

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024

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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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: WEST VALLEY MONTESSORI	FACILITY NUMBER: 197416027
	VISIT DATE: 06/12/2024

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Children have their individual basket to separately store their belongings. Napping equipment were observed in separate storage areas. LPA observed enough cribs for each child enrolled. Napping equipment does not block entrances or exits. Infant mattresses were observed to be firm with tightly fitted sheets.

Per Director wet or soiled sheets are changed as needed throughout the day. LPA observed that infant changing table has a padded surface no less than one-inch-thick and are covered with washable vinyl or plastic. The infant changing table has raised sides at least 3 inches high. LPA observed that infant changing table is not within an arm’s reach of a sink, posing a potential risk to the health and safety of children in care. Per director the room will be rearranged to make sure the changing table is next to the sink. Toilet training is not offered at this program.

Telephone service, heating, lighting and ventilation were evaluated and are in operating condition. Disinfectants, cleaning solutions, and other items that are dangerous to children, were observed to be inaccessible in cabinet with safety locks. According to the Director, medication is only administered to a child when accompanied with a doctor's note and is stored in the office inaccessible to children with the child’s name and date. Director states that there are no poisons stored at the facility and understands that storage areas for poisons must be locked with a key or combination lock. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements.

Menus were reviewed to ensure that they are being posted at least one week in advance and visible to an authorized representative. LPA observed that the children with infant formula The facility provides AM snack, lunch and PM snack for children who eat table food. Bottles, dishes, and containers of food brought by the infant’s authorized representative are labeled with infant’s name and the current date.

All food preparation areas and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. All storage containers for solid waste, including moveable bins have tight-fitting covers that are kept on, and in good repair. All foods/beverages are stored in covered containers at 45˚ (F) or less.

Outdoor space is physically separate from other child care components. Outdoor play equipment was observed to be in good condition, free of sharp, loose or pointed parts. Outdoor activity space surface is made of artificial grass on top of cushioned material. --------------------------PAGE 2

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024

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: WEST VALLEY MONTESSORI	FACILITY NUMBER: 197416027
	VISIT DATE: 06/12/2024

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The outdoor area has adequate shade and enclosed within the Preschool playground. Age appropriate toys in good repair were observed and LPA did not observe any bodies of water or firearms during this visit.

Children’s records were reviewed: Child #3's file was missing LIC 9227 infant sleep plan, posing a potential risk to children in care.

Staff records were reviewed for completeness. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a plan for providing IMS must be submitted to the Department. 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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

Facility representative was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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

Based on the LPA's observations and records review 3 "B" deficiencies are cited today 6/12/24. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Facility Representative . Appeal rights were discussed and a copy provided.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/12/2024 08:25 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: WEST VALLEY MONTESSORI	FACILITY NUMBER: 197416027
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/12/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101439(h)(4)

Infant Care Center Fixtures, Furniture, Equipment and Supplies

(h) Infant changing tables shall: (4) While in use, be placed within arm's reach of a sink. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above in that the diaper changing table is located on the other side of room not withing arms reach to sinck which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/14/2024
	Plan of Correction
1 2 3 4	Per Director the diaper changing station will be moved after children go home today. A photo of correction will be sent to LPA via email by POC due date.

Type B

Section Cited

HSC

1596.954

Licensure Requirements

Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in the carbon monoxice detector was not functioning during visit which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/14/2024
	Plan of Correction
1 2 3 4	Per Director, photo proof of correction will be sent LPA via email by POC due date.

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: Valarie Cook	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024

LIC809 (FAS) - (06/04)

Page: 4 of 5

Document Has Been Signed on 06/12/2024 08:25 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: WEST VALLEY MONTESSORI	FACILITY NUMBER: 197416027
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/12/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101429(a)(2)(B)(3)(a)

Responsibility for Providing Care and Supervision for Infants

(B) Staff shall physically check on sleeping infant(s) every 15 minutes and document the following: (3) Infants up to 12 months of age who are sleeping in a position other than on their back. (a) If the infant’s Individual Infant Sleeping Plan [LIC 9227 (3/20)] does not have Section C completed, staff shall return the infant to their back for sleeping. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on Record Review, the licensee did not comply with the section cited above in that one of one infant under 12 montha did not have completed the LIC 9227 Infant sleep plan which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/14/2024
	Plan of Correction
1 2 3 4	Per Director, an Infant Sleep plan will be completd by parent of Child #3 and a copy sent to LPA by POC due date

Section Cited

Child's Medical Assessments


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Valarie Cook	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024

LIC809 (FAS) - (06/04)

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