198009436-7-16-2019-33-CC-JDOY-BE5PNR-20190716112823

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198009436
Report Date: 07/16/2019
Date Signed: 07/16/2019 11:28:30 AM

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:	INTERNATIONAL MONTESSORI ACADEMY - WEST CAMPUS		FACILITY NUMBER:	198009436
ADMINISTRATOR:	MONICA MENDOZA		FACILITY TYPE:	850
ADDRESS:	355 GREEN ST.		TELEPHONE:	(626) 792-4505
CITY:	PASADENA	STATE: CA	ZIP CODE:	91105
CAPACITY:	92	CENSUS: 49	DATE:	07/16/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Monica Mendoza		TIME COMPLETED:	11:45 AM

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 Analyst (LPA) Justin Dorsey conducted an unannounced Annual Random Inspection. LPA met with Monica Mendoza, Director, who guided LPA on a tour of the facility. LPA inspected all areas identified on the Facility Sketch. The following staff were observed in each classroom during this visit: Room #1: Used as nap room during the summer (no children present during inspection); Room #2: Staff #1 and Staff #2 with 16 children; Room #3: Staff #3 with 11 children; Room #4: Staff #4 and Staff #5 with 11 children and Room #5: Staff #6 and Staff #7 with 11 children (children were using the play room during inspection). . Students have access to the class rooms, play room, the children's restrooms, the patio and outdoor play areas. Students of the program are signed in at the main entrance and escorted to their assigned classrooms by parents or teachers. The facility does not provide transportation, children are dropped off and picked up by their parents. Furniture and equipment are safe and in good repair. There is heating, lighting and ventilation available at the facility. The teachers communicate through an intercom system. The changing room is used as an isolation area and the adult restroom is designated for the use of ill children if needed. Per director no children are changed in the changing room if there is a sick child in there. Drinking water is available indoors and outdoors. Restrooms used were inspected for availability, good repair, water temperature, toilet paper, area safety and sanitation. The kitchen, which the students don't have access to is located across from Room #3. Lunch is provided by the parents, the facility does offer snacks for the children if needed. Containers used to discard food have tight fitting lid at this time. Snack menus were posted on the parents bulletin board. Snacks were reviewed for availability, quantity and appropriateness to children in care. Poisons are locked in a cabinet in the kitchen. Cleaning compounds and sharp items are inaccessible.

SUPERVISOR'S NAME: Adriana Hernandez	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Justin Dorsey	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019

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: INTERNATIONAL MONTESSORI ACADEMY - WEST CAMPUS	FACILITY NUMBER: 198009436
	VISIT DATE: 07/16/2019

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The outdoor play area includes play equipment and benches for children, the facility has adequate shade sails for shade. The play area is fully fenced. LPA observed that staff have current First Aid and CPR (Expires 10/2020). Staff has met all immunization requirements. Ratios were observed to be in compliance. First Aid supplies are available. Disaster drills are documented and all posting requirements have been met.

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 Child Care Centers Sections 101173 and 101226.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
REMINDER: Failure to obtain a criminal record background check clearance prior to initial presence will result in an immediate $100.00 dollar or more.

LPA advised how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov. Also, discussed new requirements for providers, including mandate reporting training for staff which can be found at: http:/www.mandatedreporterca.com/training /training.htm. This is a new regulatory requirement beginning January 2018. According to staff, training has been completed through Community Care Licensing. Please review all elements outlined in AB 1207- Mandated Reporting Training.

No deficiencies were cited in accordance with California Code of Regulations Title 22. The
Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing reprehensive. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Director Monica Mendoza, Appeal Rights were given.

SUPERVISOR'S NAME: Adriana Hernandez	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Justin Dorsey	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019

LIC809 (FAS) - (06/04)

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