198003766-4-11-2022-33-CC-CTUA-CDE2UC-20220411174206

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198003766
Report Date: 04/11/2022
Date Signed: 04/11/2022 05:42:22 PM

Document Has Been Signed on 04/11/2022 05:42 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	NEW MONTESSORI SCHOOL, THE		FACILITY NUMBER:	198003766
ADMINISTRATOR:	GERALDINE SHAUGHNESSY		FACILITY TYPE:	840
ADDRESS:	15243 E. NELSON AVENUE		TELEPHONE:	(626) 369-4335
CITY:	LA PUENTE	STATE: CA	ZIP CODE:	91744
CAPACITY:	20	CENSUS: 11	DATE:	04/11/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Geraldine Shaughnessy		TIME COMPLETED:	06:00 PM

NARRATIVE

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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	An unannounced Required Annual Inspection was conducted on this day by Licensing Program Analysts (LPAs) Carolyn Tuba and Nolan Tcheng. Facility is currently licensed for a capacity of 20 School Age Children. Licensing staff met with Director Geraldine (Gerry) Shaughnessy who guided LPAs on an indoor and outdoor tour of the facility. The program currently operates Monday thru Friday from 2:30pm to 6:00pm on school days only. Per Director, the School Age children do not attend when school is on breaks such as Summer, Winter, Spring Breaks. LPAs observed that the classroom where the School Age children attend is used by an on-site Educational Program. Per Director, the Educational Program is separate from the School Age Licensed and is overseen by the California Department of Education (CDE). Director also stated that the school children start their day at 6:00am and end their day at 6:00pm and are not enrolled in the School Age after school day care program that is licensed by Community Care Licensing (CCL). LPAs advised Director to ensure that any children from the Educational Program that are present on-site after school should be enrolled into one of the facility's licenses. After further discussion with Director, it was determined that the Educational Program and the School Age children use the same classroom, especially during inclement weather. Director stated that the School Age children will be on one side of the classroom and the Educational Program will be on the other side of the classroom and they are separated by positioned shelves. Licensing staff spoke over the phone with Owner Gamil Tawfik, who stated that this educational program has been at Page 1 of 5

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn Tuba	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2022

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: NEW MONTESSORI SCHOOL, THE	FACILITY NUMBER: 198003766
	VISIT DATE: 04/11/2022

NARRATIVE

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this facility since they applied for the licenses with CCL and no one from licensing staff has pointed out an issue until 03/08/2018 when facility was cited for the same violation. Owner states they appealed the citation but did not hear anything back and assumed it was fixed. Licensing staff obtained a copy of the appeal that the owner sent in 2018. There is no physical proof on site of the educational program being through the CDE. Licensing staff looked on the CDE website and observed New Montessori School on it as a Private Elementary School for K-3rd grade children at the facility address on file. CDS Code: #1973445708213. Licensing staff discussed with owner that the school age room was licensed for the school age license under our Department. Having another program sharing the same room at the same time as the licensed program is a violation of Title 22 regulations. The shared space is considered commingling. Licensing staff will work with the facility on bringing them back into compliance. At the initial start of the site visit, there were no School Age children present. Furniture and equipment was inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Storage for children's belongings was observed. Mat/cot was inspected. Availability of drinking water was reviewed. Age appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, area safety and sanitation. Toys observed to be clean.
A first aid kit is kept in the classroom. Smoke detectors are present in the facility. Fire extinguishers have been serviced in June 2021. Snack menus were reviewed. Food and snacks were reviewed for availability, quantity and appropriateness to children in care. Food preparation areas were toured for safety, cleanliness and proper equipment. Per Director, facility provides an afternoon snack to children.

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SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn Tuba	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2022

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: NEW MONTESSORI SCHOOL, THE	FACILITY NUMBER: 198003766
	VISIT DATE: 04/11/2022

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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 Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and Carbon Monoxide detectors should be checked and batteries replaced as needed. Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your location.Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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 Centers and the ADA, available at: http://www.ada.gov/childqanda.htm
Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed. The Director was advised how to access forms and Regulations online at www.ccld.ca.gov

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SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn Tuba	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2022

LIC809 (FAS) - (06/04)

Page: 3 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: NEW MONTESSORI SCHOOL, THE	FACILITY NUMBER: 198003766
	VISIT DATE: 04/11/2022

NARRATIVE

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LPAs advised Director that all adults 18 years of age and older providing Care & Supervision and/or have continuous presence in the facility shall adhere to a criminal background clearance with the Department of Justice, FBI and Child Abuse Index Check. LPA informed Director to log onto web site www.ccld.ca.gov to obtain forms and LIVE SCAN application. Records for all children and staff must be maintained for three (3) years after separation from the facility.

The Director was also advised of the requirement to report Unusual Incidents and/or injuries to the parent/guardian and to CCL within the time frame specified by the regulation. Director advised to visit www.shotsforschool.org for immunization information.

See deficiencies page for deficiencies cited during today's visit in accordance to the California Code of Regulations Title 22, Division 12, Chapter 1

Upon receipt of this report, the Licensee shall post the Notice of Site Visit and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement of Receipt (LIC 9224 form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224) Form during this visit.

Exit interview, copy of report was given. Appeal rights were issued and discussed.
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SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn Tuba	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2022

LIC809 (FAS) - (06/04)

Page: 4 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: NEW MONTESSORI SCHOOL, THE	FACILITY NUMBER: 198003766
	VISIT DATE: 04/11/2022

NARRATIVE

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Outdoor equipment was inspected for safety, cushioning material, good repair and appropriateness. Required shade, drinking water and fencing were inspected. LPA Lucero advised Director that the children need to be within the direct care and supervision, including visual supervision of the teacher(s) at all times. The children have access to drinking fountains during outside play. Play area was inspected for hazards and inaccessibility to bodies of water; no bodies of water or hazards observed.

Staff and Children’s Records were reviewed. Criminal Record Clearances were reviewed for adults. CPR card expires in 04/05/2023 for Director. Inspection of required forms made.

Upon receipt of this report, the Licensee shall post the Notice of Site Visit and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement of Receipt (LIC 9224 form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224) Form during this visit.

Exit interview, copy of report was given. Appeal rights were issued and discussed.

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SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn Tuba	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2022

LIC809 (FAS) - (06/04)

Page: 5 of 6

Document Has Been Signed on 04/11/2022 05:42 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: NEW MONTESSORI SCHOOL, THE	FACILITY NUMBER: 198003766
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/11/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

101161(a)

(a) The licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation 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, as the facility is having a license-exempt program share the licensed space for the facility with children enrolled in the licensed program, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 04/18/2022
	Plan of Correction
1 2 3 4	Director agreed to provide a written plan that ensures compliance with Title 22 regulations.

Section Cited


	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: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn Tuba	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2022

LIC809 (FAS) - (06/04)

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