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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011974
Report Date: 12/02/2022
Date Signed: 12/02/2022 02:39:16 PM


Document Has Been Signed on 12/02/2022 02:39 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 CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:MONTESSORI ON ELM PRESCHOOL + KINDERGARTENFACILITY NUMBER:
198011974
ADMINISTRATOR:WIJEYEWICKREMA, CASSANDRAFACILITY TYPE:
830
ADDRESS:930 ELM AVENUETELEPHONE:
(562) 570-8080
CITY:LONG BEACHSTATE: CAZIP CODE:
90813
CAPACITY:24CENSUS: 19DATE:
12/02/2022
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME BEGAN:
11:36 AM
MET WITH:Cassandra Wijeyewickrema TIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Raul Navarro conducted an unannounced annual inspection on 12/02/2022 at 11:36AM. LPA met with Licensee Cassandra Wijeyewickrema, who guided analyst on a tour of the facility. This is an infant program which consists of one classroom. Facility operation hours are Monday to Friday from 7:00 AM to 5:00 PM.

The infant program is located adjacent to the center's pre-school program. The infant program has no shared areas. All areas identified on the Facility Sketch were inspected. The following staff were present during this inspection: Room 1: Staff #1 and #2, with 7 infants; Room 2: Staff #3 and #4 with 8 infants; and Room 3: Staff #5 with 4 infants. Teacher - infant ratios were observed to be in accordance with Title 22 regulations. The facility is within the conditions, limitations, and capacity specified on the license. Staff names were recorded. All children were observed to be under visual supervision of a teacher at all times. Classrooms were observed to ensure that infants are never left unattended and under the direct visual supervision of a staff person at all times.

Furniture and equipment were inspected for age appropriateness and good repair. The facility has sufficient napping equipment, feeding chairs, and changing tables. Cribs were observed to be free from loose articles and objects including blankets, pillows and no objects were observed to be hanging above or to the side of the cribs.



The facility has a separate napping area and the nap area was observed to have a half wall that allows for constant auditory and visual supervision. Telephone service, heating, lighting and ventilation were evaluated. Children have their own cubby to store their belongings. Linens are taken home each week to be washed. Age appropriate sinks and toilets were inspected for availability and good repair in all restrooms. General sanitation was observed. Availability of indoor drinking water was observed in classrooms.

Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. Carbon monoxide detectors were observed and are operable.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:
DATE: 12/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/02/2022
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MONTESSORI ON ELM PRESCHOOL + KINDERGARTEN
FACILITY NUMBER: 198011974
VISIT DATE: 12/02/2022
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All kitchen areas/food preparation areas and food storage areas are kept clean and are free of litter, rubbish, rodents, or any other vermin. All storage containers for solid waste, including moveable bins have tight-fitting covers that are kept on, and are in good repair. Trash cans used to discard food have tight fitting lids or solid waste bags are discarded immediately after each meal. LPA reminded Director that food and bottles that are brought from home need to be labeled with the children's name and properly refrigerator. Per Director, an am snack is provided to the children.

The outdoor playground was observed to be physically separate from the preschool component. Outdoor playground equipment is in a safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All areas around or under climbing equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard. Availability of outdoor drinking water was observed. LPA advised that no children shall be left without the supervision of a teacher at any time.

All floors were observed to be clean and safe. All materials accessible to children were observed to be toxic free. There are no firearms stored on the premises. There are no pools or bodies of water at the facility.

All individuals present have obtained a criminal record clearance or criminal record exemption. There is at least one person trained in CPR and Pediatric First Aid present during this inspection.

Children’s records were reviewed for Immunization Records, LIC 700- Identification and Emergency Information, LIC 702- Health History, LIC 701- Physicians Report, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, LIC 613A- Personal Rights, LIC 9227- Infant sleep form (0-12 months, and documentation of 15-minute Infant Sleep Check (0-24 months).



Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunization against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate. During file review. LPA observed two staff need to retake the Mandated Reporter Training because it had expired. A technical violation was given.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MONTESSORI ON ELM PRESCHOOL + KINDERGARTEN
FACILITY NUMBER: 198011974
VISIT DATE: 12/02/2022
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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

Licensee was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

At this time, the facility is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today. Exit interview was conducted with Licensee,Cassandra Wijeyewickrema.

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 representative. Failure to maintain posting as required will result in a civil penalty of $100.00.



To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4