<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419826
Report Date: 03/18/2020
Date Signed: 03/18/2020 01:36:46 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:MONTESSORI ON COPPER HILLFACILITY NUMBER:
197419826
ADMINISTRATOR:BISHAN, SENEVIRATNEFACILITY TYPE:
850
ADDRESS:27908 SECO CANYON ROADTELEPHONE:
(661) 673-5676
CITY:SANTA CLARITASTATE: CAZIP CODE:
91350
CAPACITY:143CENSUS: 5DATE:
03/18/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:41 PM
MET WITH:Michelle Satorheli, DirectorTIME COMPLETED:
01:40 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
Licensing Program Analysts (LPAs) Monqiue Ayala and Isabel Ortega conducted a Case Management inspection. During this inspection the following violation was observed:

LPAs Ayala and Ortega requested to view the facility video recording and observed that on 03/18/2020, staff #1 failed to redirect child #1 to accompany her, instead staff #1 handled child #1 in a rough manner by grabbing child #1 from underneath child #1 armpits and failed to redirect child #1. Child #1 did not sustain any physical injuries during the incident.

Facility was issued a type B deficiency. Please see Facility Evaluation Report LIC 809D for deficiencies cited.

An exit interview was conducted with director and a copy of this report was provided along with appeal rights.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 369-2168
LICENSING EVALUATOR NAME: Monique Jessica AyalaTELEPHONE: (661) 202-3365
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2020
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: MONTESSORI ON COPPER HILL
FACILITY NUMBER: 197419826
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/18/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/19/2020
Section Cited

1
2
3
4
5
6
7
Personal Rights: The licensee shall ensure that each child is accorded the following personal rights: The licensee shall ensure that each child is accorded the following personal rights: To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive
8
9
10
11
12
13
14
nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting... This requirement is not met as evidenced by: Staff #1 violated the personal rights of child #1 by handling child in an inappropriate manner. LPAs observed surveillance video dated 03/18/2020. This poses a potential health and safety risk.
8
9
10
11
12
13
14

1
2
3
4
5
6
7

1
2
3
4
5
6
7
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: Mariela RamonTELEPHONE: (661) 369-2168
LICENSING EVALUATOR NAME: Monique Jessica AyalaTELEPHONE: (661) 202-3365
LICENSING EVALUATOR SIGNATURE:
DATE: 03/18/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/18/2020
LIC809 (FAS) - (06/04)
Page: 2 of 2