197419827-6-28-2022-12-CC-LSTN-CFTVD2-20220628162002

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197419827
Report Date: 06/28/2022
Date Signed: 06/28/2022 04:20:08 PM

Document Has Been Signed on 06/28/2022 04:20 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	MONTESSORI ON COPPER HILL INFANT CENTER		FACILITY NUMBER:	197419827
ADMINISTRATOR:	BISHAN SENEVIRATNE		FACILITY TYPE:	830
ADDRESS:	27908 SECO CANYON ROAD		TELEPHONE:	(661) 607-2333
CITY:	SANTA CLARITA	STATE: CA	ZIP CODE:	91350
CAPACITY:	40	CENSUS: 6	DATE:	06/28/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	03:04 PM
MET WITH:	Suzanne Naber, Assistant Director		TIME COMPLETED:	04:35 PM

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On 06/28/22, Licensing Program Analyst (LPA) Liana Stepanyan, met with the Assistant Director Suzanne Naber, to conduct an unannounced annual random inspection for the infant program which also contains a toddler component. Upon arrival, LPA observed 1 infant under care of supervision of 1 staff member. LPA also observed 5 toddlers under care and supervision of 1 staff member. The operation hours for the infant program is 6:30am-6:30pm.

The facility roster was up to date and all staff have been fingerprinted and association to the designated license number. Director and teachers are currently certified in Pediatric CPR/First Aid.

The facility maintains a sign in/out sheet to verify the current census of children. The parent board was reviewed and has all the required forms posted accessible to parents.

Physical Plant: Indoor and Outdoor activity space is physically separate from space used by children in the preschool/school age component; surface of outdoor activity space is maintained in safe condition free of hazards; solid waste storage containers have tight fitting covers; no baby walker observed (prohibited item), there is appropriate furniture and equipment (cots, cribs, changing table, feeding chairs); furniture is maintained in good repair and safe condition; toys are safe, have no sharp points or edges or splinters, no small parts that can be pulled off or swallowed observed.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Liana Stepanyan	TELEPHONE: 661-202-3380
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022

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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: MONTESSORI ON COPPER HILL INFANT CENTER	FACILITY NUMBER: 197419827
	VISIT DATE: 06/28/2022

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Equipment and toys are cleaned with detergent/disinfectant after each use. There is one sink to every 15 infants and one potty chair to every 5 infants being toilet trained. Infant is not left without supervision or unattended. Facility is in compliance with staff-infant ratio (one teacher for every four infants).
Napping equipment – each crib/cot occupied by only one infant at a time, bedding changed daily or as needed, cribs/cots arranged to provide a walkway between for staff to reach each infant without having to step over or reach over any other infant.
Changing table – padding no less than one-inch thick and covered with washable plastic, in good repair, within arm’s reach of the sink.

Facility food is safe, stored, prepared and served in a safe manner in the kitchen, food preparation and storage areas are clean; dishes and utensils are clean and sanitized; menu posted one week or more in advance. Facility serves snack, lunch and snack. Food preparation area is not being used for play activities or napping; food and beverages stored in covered containers at 45 degrees or less, no food damaged containers were observed.

The outdoor play areas were inspected and observed to be free of hazards, loose, or sharp objects. Equipment was inspected for safety, cushioning material, good repair and age appropriateness. Climbing structures other large play equipment were found to be securely anchored with adequate resilient cushioning material underneath and around the perimeter. Children are also provided their own individual labeled water bottles. There is adequate shade area for rest. The playground is well fenced all around, and no bodies of water observed in the outdoor play area.

Medications inaccessible to children; all prescription and nonprescription medications have child’s name and are dated; written consent and instruction from child’s representative; a plan to document and report to child’s representative when medication is administered to a child; IMS plan on file (if applicable).

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Liana Stepanyan	TELEPHONE: 661-202-3380
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022

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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: MONTESSORI ON COPPER HILL INFANT CENTER	FACILITY NUMBER: 197419827
	VISIT DATE: 06/28/2022

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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 Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 Centers and the ADA, available at: http://www.ada.gov/childquanda.htm

Director advised of the requirement to report Unusual Incidents. Licensee informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department (email address on the website: www.unusualincidentreport@dss.ca.gov). A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above.

The facility is in compliance with Title 22, no deficiencies are cited.

A copy of this report must be made available to the public for 3 years.

A notice of site visit was given and must remain posted for 30 day.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview conducted, copy of this report was reviewed and provided to Director.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Liana Stepanyan	TELEPHONE: 661-202-3380
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022

LIC809 (FAS) - (06/04)

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