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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419680
Report Date: 03/02/2023
Date Signed: 03/02/2023 03:35:26 PM


Document Has Been Signed on 03/02/2023 03:35 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:PALOS VERDES MONTESSORI ACADEMYFACILITY NUMBER:
197419680
ADMINISTRATOR:OFELIA WATANABE & MS. HAQFACILITY TYPE:
830
ADDRESS:28451 INDIAN PEAK RDTELEPHONE:
(310) 541-2405
CITY:RANCHO PALOS VERDESSTATE: CAZIP CODE:
90274
CAPACITY:24CENSUS: 21DATE:
03/02/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Eliza Byrd, DirectorTIME COMPLETED:
03:55 PM
NARRATIVE
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On March 2, 2023 @ 9:45 AM, Licensing Program Analyst (LPA) Miriam Cohen conducted a Case Management Incident inspection to follow up on the self-reported incident that occurred on 02/09/2023 at Paos Verdes Montessori Academy Infant Center (Infant center with a Toddler component), facility number 197419680 located at 28451 Indian Peak Road, Rancho Palos Verdes, CA 90274. The El Segundo Regional Office received the incident report on 02/10/2023. LPA Cohen met with preschool director, Eliza Byrd, and stated the purpose for the visit. Upon arrival, LPA observed 21 children (nine infants and 12 toddlers) being supervised by 6 adults. All center staff members that was present during today’s inspection had fingerprint clearance and associated to the designated license number. Based on the information that were gathered through interviews, documentation submitted to the department, and physical plant inspection of the site of the incident (toddler outdoor play area), it revealed that on the day of the incident, there were nine children being supervised by three adults (one of the staff members went inside the classroom to change a child’s diaper). Per interview with the director, at approximately 4:20 PM, a parent observed a child (C1) sitting in a corner, outside in the toddler play area, alone and without an adult supervision. The parent informed one of the teachers (S1), who immediately took the child back inside the classroom. The director immediately discussed the incident and reviewed counting protocols when transitioning from outdoors to indoors, and vice-versa, with all Infant and Toddler teachers. Write ups were issued including the termination of the teacher in charge of C1 during the incident. Director notified parent of C1 concerning the incident and provided information on the consequences for the teacher in charge of C1 during the incident. As of 03/02/2023, C1 remained enroll in the Infant Center. Based on the available information: LIC 624 (UIR form), interview with the director, and physical observation of the site where the incident occurred, it appears that the incident was the result of a Title 22 violation for lack of supervision. A type A citation was issued. The content of this report was read and discussed in detail at the time of inspection with Infant Center Director. An exit interview was conducted, and a copy of appeal rights was provided. A copy of this report must be given to all parents and to the parents of any child enrolling within the next 12 months. Licensee is to post notice of Site Visit for 30 Days upon receipt, failure to do so will result in $100 immediate civil penalty.
SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Miriam CohenTELEPHONE: (424) 301-3058
LICENSING EVALUATOR SIGNATURE:
DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2023
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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Document Has Been Signed on 03/02/2023 03:35 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: PALOS VERDES MONTESSORI ACADEMY
FACILITY NUMBER: 197419680

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/02/2023
Section Cited

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Responsibility for Providing Care and Supervision
The licensee shall provide care and supervision as necessary to meet the children's needs.
A child was observed left alone in the playground without supervision. The requirement is not met as evidenced by
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The director immediately discussed the incident and reviewed counting protocols when transitioning from outdoors to indoors, and vice-versa, with all Infant and Toddler teachers. Write ups were issued including the termination of the teacher in charge of C1 during the incident.
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interviews of program director, submitted LIC 624/UIR form, and physical observation of the site where incident occurred. This poses an immediate 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: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Miriam CohenTELEPHONE: (424) 301-3058
LICENSING EVALUATOR SIGNATURE:
DATE: 03/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2023
LIC809 (FAS) - (06/04)
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