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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011043
Report Date: 10/10/2023
Date Signed: 10/10/2023 05:57:38 PM

Document Has Been Signed on 10/10/2023 05:57 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:TELSTAR MONTESSORI CHILD CARE CENTERFACILITY NUMBER:
198011043
ADMINISTRATOR:GABRIELA DOMINGUEZFACILITY TYPE:
830
ADDRESS:9320 TELSTAR AVENUETELEPHONE:
(626) 569-2640
CITY:EL MONTESTATE: CAZIP CODE:
91731
CAPACITY: 15TOTAL ENROLLED CHILDREN: 13CENSUS: 12DATE:
10/10/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Director Gabby DomminguezTIME COMPLETED:
06:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Roxana Lopez conducted a Case Management-Deficiencies visit on this date to address deficiencies revealed during an inspection.

LPA initially arrived to the facility at 1:00 pm and was guided on a tour of both preschool and infant facility. Upon entry of the infant classroom LPA observed 6 infants in the classroom 2 asleep on mats. Infant # 1 was observed to be swaddled with a thick blanket and head was on a boppy pillow, laying on a mat. Infant # 2 was observed to be sleeping on a mat with a blanket on top and a sound machine laying next to their head. LPA then proceeded into the napping room where LPA observed 6 infants 5 were asleep. 4 of the sleeping infants were observed on cots with blankets and 1 infant was observed asleep in a crib with a blanket hanging from the rails and a sound machine next to their head. This poses an immediate health and safety risk for children in care.

Based on LPA observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health and safety.

LPA Roxana Lopez informed facility representative Gabby Dominguez that this report dated 10/10/2023 document(s) 2 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. Also, LPA Roxana Lopez informed the facility representative to provide a copy of this licensing report dated 10/10/2023 that documents any Type A citation(s) to parents/guardians of all children currently enrolled
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Brandi VanOosten
Roxana Lopez
DATE: 10/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2023
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 4
Document Has Been Signed on 10/10/2023 05:57 PM - It Cannot Be Edited


Created By: Roxana Lopez On 10/10/2023 at 04:56 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: TELSTAR MONTESSORI CHILD CARE CENTER
FACILITY NUMBER: 198011043

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/10/2023
Section Cited

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101430 Infant Care Activities(3)All infants shall be given the opportunity to sleep without distraction or disturbance from other activities at the center whenever the infant desires.(C) An infant shall not be swaddled while in care. This requirement was not met as evidenced by
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Based on LPA observation, the licensee did not comply with the section cited above in that Infant # 1 was observed to swaddled with a thick blanket, head on a boppy pillow laying on a mat. This poses an immediate health, safety or personal rights risk to persons in care.
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Type A
10/10/2023
Section Cited

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101439.1 Infant Care Center Sleeping Equipment (f) Cribs shall be free from all loose articles and objects, including blankets and pillows. This requirement was not met as evidenced by
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Based on LPA observation, the licensee did not comply with the section cited above in that LPA observed 1 infant sleeping in a crib with a blanket hanging from the rails and a sound machine next to their head. Additionally, LPA observed 4 infants sleeping on mats with blankets.
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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:Brandi VanOosten
TELEPHONE:
LICENSING EVALUATOR NAME:Roxana Lopez
TELEPHONE:
LICENSING EVALUATOR SIGNATURE:
DATE: 10/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/10/2023


LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 10/10/2023 05:57 PM - It Cannot Be Edited


Created By: Roxana Lopez On 10/10/2023 at 05:07 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: TELSTAR MONTESSORI CHILD CARE CENTER
FACILITY NUMBER: 198011043

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/31/2023
Section Cited

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101438.3(c)(1)Indoor Activity Space For Infants(1) The sleeping area for infants shall be physically separate from the indoor activity space. This separation shall be accomplished as specified in (b) above.
This requirement is not met as evidenced by:
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Based on LPA observation the licensee did not comply with the section cited above in that LPA observed 2 infants sleeping in the classroom rather than the designated nap area which poses a potential health, safety or personal rights risk to persons 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:Brandi VanOosten
TELEPHONE:
LICENSING EVALUATOR NAME:Roxana Lopez
TELEPHONE:
LICENSING EVALUATOR SIGNATURE:
DATE: 10/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/10/2023


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: TELSTAR MONTESSORI CHILD CARE CENTER
FACILITY NUMBER: 198011043
VISIT DATE: 10/10/2023
NARRATIVE
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by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the facility representative Gabby Dominguez

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SUPERVISOR'S NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023
LIC809 (FAS) - (06/04)
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