198010717-8-13-2019-33-CC-CRES-BF23BX-20190813180703

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198010717
Report Date: 08/13/2019
Date Signed: 08/13/2019 06:07:09 PM

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:	MONTESSORI ACADEMY OF WEST COVINA		FACILITY NUMBER:	198010717
ADMINISTRATOR:	ZAFIRA FIRDOSY		FACILITY TYPE:	830
ADDRESS:	1030 E. MERCED AVENUE		TELEPHONE:	(626) 917-0767
CITY:	WEST COVINA	STATE: CA	ZIP CODE:	91790
CAPACITY:	12	CENSUS:	DATE:	08/13/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Daniella Perez and Ghada Ponce		TIME COMPLETED:	06:06 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	An unannounced Random Site Inspection was conducted on this date, by Cynthia Reyes and Alicia Mooberry, Licensing Program Analysts (LPA). All areas identified on the Facility Sketch were inspected and checked the following: Fingerprint clearances, staff/child ratio, children and staff records, food preparation area, storage and refrigeration, rest rooms, equipment, outside play area and over all conditions of facility. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Napping equipment and bedding was inspected for good condition. High Chairs, feeding tables, trays, changing tables, cribs & bedding identification were inspected. Appropriate storage and cleanliness. Storage for children's belongings and an isolation area with a sink, toilet, and mats/cots was inspected. Availability of drinking water was reviewed. Age appropriate sinks and toilets were inspected for availability, good repair, water temperatures, toilet paper, paper towels, area safety and sanitation. First Aid supplies were inventoried. A review of medication policy, including administering, labeling, storage, and records was made. (Please contact your analyst for regulations if considering using Nebulizer or administering Blood-Glucose testing.) Incidental Medical Services was discussed. Day-care days and hours M-F 6:30 AM-6:00 PM. **Licensee advised that signing the report does not imply agreement with the findings but is acknowledging receipt of the licensing report. Web site address to order forms: http://www.dss.cahwnet.gov/cdssweb/On-lineFor_293.htm#l** INTERNET ADDRESS: http://www.ccld.ca.gov – To access licensing forms, updates and Title 22.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Cynthia Reyes	TELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019

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: MONTESSORI ACADEMY OF WEST COVINA	FACILITY NUMBER: 198010717
	VISIT DATE: 08/13/2019

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AM/PM Snack provided, lunch is provided by outside catering company. Snack and lunch menus were reviewed. Food preparation areas were toured for safety, cleanliness and proper equipment. A review of cleaning and food supply storage areas was made. Outdoor equipment was inspected for safety, cushioning material, good repair and age appropriateness. Required shade, drinking water and fencing were inspected. Play area was inspected for hazards and inaccessibility to bodies of water. Teacher child ratios were observed and staff names recorded. Care and supervision was evaluated to determine if the basic needs of children are met appropriately. Staff was questioned to establish their familiarity of emergency reporting requirements, emergency disaster plans and other site operations. Sign in and out sheets and procedures were reviewed with staff, policy of checking children for illnesses. Personal Rights of children were discussed and observed by LPA. Transportation policy and procedures were reviewed for safety requirements. Staff and children records were reviewed for completeness including but not limited to Criminal Record Clearances for adults, Director Qualifications and verification of Pediatric CPR/First Aid and health preventive practices documentation. Inspection of required forms was made. Children and Staff confidential name report (lic 811) was given and documented on this date. No weapons or bodies of water on premises. The smoke detectors, carbon monoxide & fire extinguisher are in operable condition.

AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: http://mandatedreporterca.com/

The following deficiencies were observed in accordance to Title 22 of the California Code of Regulations. No citation and consultation was conducted on this date.
Printer is needed for the facility to ensure all forms are printed dark and legible.

A copy of this report and all other Licensing reports must be made available to the public for 3 years.

Upon receipt, Licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

Exit interview was conducted including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Cynthia Reyes	TELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019

LIC809 (FAS) - (06/04)

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