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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419826
Report Date: 05/13/2020
Date Signed: 05/13/2020 02:56:34 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: 0DATE:
05/13/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Michelle Satorheli, DirectorTIME COMPLETED:
03:30 PM
NARRATIVE
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On 5/13/2020 at 2:30 PM, Licensing Program Analyst (LPA) Monique Ayala conducted a tele-visit Case Management inspection via Facetime with facility director.

LPA informed Director that the Department has learned that staff #1, staff #2, staff #3 and staff #4 have restrained child #1, child #2 and child #3 on several occasions.

The information obtained revealed that staff #1 restrained child #1 by placing child #1 on staff #1 lap, staff #1 would place her leg on child #1 to restrain child #1 from getting up and staff #1 would push child #1 chair close enough into the table so it became difficult for child #1 to get up from his/her seat. Staff #1 restrained child #2 by placing child #2 on her lap, and child #2 wiggled his/her way down until child #2 was laid on his/her back. Staff #1 continued to restrain child #2 by holding the child #2 leg while child #2 was flat on his/her back. Staff #2 restrained child #3 on her lap to assist in redirecting behavior when child #3 was either harming his/herself or harming other children.

Staff #2 and staff #3 have restrained children on their lap to redirect children's behavior and avoid children in harming themselves or others.

Staff #4 restrained child #3 by placing child on her lap to assist in redirecting behavior when child #3 was either harming his/herself or harming other children.

Staff #1, staff #2, staff #3 and staff #4 attempts to redirecting children resulted in the violation of the personal rights of child #1, child #2 and child #3. It has also confirmed that the children’s restraining did not result in physical injuries to the children.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 369-2168
LICENSING EVALUATOR NAME: Monique Jessica AyalaTELEPHONE: (661) 202-3365
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2020
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 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MONTESSORI ON COPPER HILL
FACILITY NUMBER: 197419826
VISIT DATE: 05/13/2020
NARRATIVE
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Facility did not comply according to the California Code Title 22 Regulations under Personal Rights. Therefore, a Type A deficiency is cited.

Please see Facility Evaluation Report LIC 809D for deficiency cited.

Upon receipt of a Type A deficiency, the facility shall post the report for 30 days. In addition, this report must be provided to parents/guardians of children and newly enrolled at the facility during the next 12 months & facility shall obtain a signed Acknowledgement of Receipt Licensing Reports (LIC 9224) from parent/guardian & place signed form in each child's file. If these requirements are not met, civil penalties will be assessed.

An exit interview was conducted with director, a copy of this report, appeal rights and notice of tele-visit was provided via email to Director on this date.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 369-2168
LICENSING EVALUATOR NAME: Monique Jessica AyalaTELEPHONE: (661) 202-3365
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2020
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, 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: 05/13/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
05/14/2020
Section Cited

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The licensee shall ensure that each child is accorded the following personal rights: To be accorded dignity in his/her personal relationships with staff and other persons. This requirement was not met as evidence by staff disclosures stating children are being restrained.
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Which poses an immediate Health, Safety or Personal Rights risk to 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: Mariela RamonTELEPHONE: (661) 369-2168
LICENSING EVALUATOR NAME: Monique Jessica AyalaTELEPHONE: (661) 202-3365
LICENSING EVALUATOR SIGNATURE:
DATE: 05/13/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/13/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3