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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198012295
Report Date: 11/22/2019
Date Signed: 11/22/2019 04:51:06 PM

COMPREHENSIVE INSPECTION
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:AGAPE MONTESSORI SCHOOLFACILITY NUMBER:
198012295
ADMINISTRATOR:AMY LIUFACILITY TYPE:
850
ADDRESS:9537 TELSTAR AVENUETELEPHONE:
(626) 450-7686
CITY:EL MONTESTATE: CAZIP CODE:
91731
CAPACITY:75CENSUS: 41DATE:
11/22/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:24 AM
MET WITH:Amy Liu, DirectorTIME COMPLETED:
04:50 PM
NARRATIVE
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Licensing Program Analyst (LPA) Mireya Garcia conducted an unannounced annual random inspection. LPA met with Amy Liu, Director, who guided analyst on a tour of the facility. This is a preschool program which consists of five (5) classrooms; RM A, RM B, RM C and RM D. Facility operation hours are Monday to Friday from 7:30 AM to 6:00 PM.

All areas identified on this report were inspected. Upon arrival, the following staff were present during this inspection: Room A: Staff #1, and #2 with 13 preschoolers; Room B: Staff #3 and #4 with 16 preschoolers and Room C: Staff #5 and #6 with 12 preschoolers. The following was observed during the tour of the facility:

PHYSICAL PLANT



Upon entering facility LPA observed no one in the front office available. LPA proceeded to the hallway classroom area of the facility and observed children transitioning from outside to inside classrooms. While LPA waited for Director LPA observed five children in the hallway hanging their bag packs with no adult present. Staff #1 came out of Room A and took children inside classroom. Upon entering Room: A, LPA asked Staff #1 and #2 for the classroom census. Staff #1 and #2 provided a census of 13, LPA counted 12 children present; and asked Staff #1 and #2 to count the children in the room that is when Staff #1 and #2 noticed they were missing a child. Staff #1 and #2 did not know where child #1 was at. Director and LPA left the classroom and found missing child #1 inside classroom B. LPA Garcia advised Staff and Director that the children need to be within the direct care and supervision, including visual supervision, of the teacher(s) and supervising staff at all times.

REPORT CONTINUES ON THE NEXT PAGE 1 OF 4

SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2019
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 8
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: AGAPE MONTESSORI SCHOOL
FACILITY NUMBER: 198012295
VISIT DATE: 11/22/2019
NARRATIVE
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Furniture and equipment were inspected for age appropriateness and good repair. 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. Napping equipment (cots) were observed in a separate storage room. LPA did observe that in RM A, RM B, RM C, RM D and RM E and in the classrooms hallway they were missing electric outlet covers during this inspection. LPA observed in Room B near the circle time area of the room the wall has holes which is exposing drywall. In addition, LPA also observed upon the hallway entrance chipping drywall metal exposed by the entrance to the classrooms. Per Director, the isolation area is located in the office. Age appropriate sinks and toilets were inspected for availability and observed 1 toilet in Room C is not in service and observed to be covered with a out of order sign (Pictures were taken). Per Director, a service call will be placed for the toilet and drywall exposures. General sanitation was observed. Availability of drinking water was reviewed indoor and outdoor. The children have access to drinking water in a jug with disposable cups inside and during outside play.

Disinfectants and cleaning solutions (Disinfectant wipes, Comet, Awesome-all purpose concentrated cleaner) were observed to be stored in Room A, Room B, Room C and in Room D located underneath the classroom’s sink cabinet (Pictures were taken). Disinfectants and cleaning solutions were immediately removed by Director and were stored in an inaccessible area. Director states that there are no poisons stored at the facility.

All kitchen areas/food preparation areas and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair. There are no trash cans with tight fitting lids in the classrooms. However, Director states that trash is removed from the classroom right after meal times.

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 high climbing equipment, swings, slides, and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard.

REPORT CONTINUES ON THE NEXT PAGE 2 OF 4

SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2019
LIC809 (FAS) - (06/04)
Page: 2 of 8
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: AGAPE MONTESSORI SCHOOL
FACILITY NUMBER: 198012295
VISIT DATE: 11/22/2019
NARRATIVE
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FACILITY RECORDS

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 completeness; Inspection of required forms was made. LPA issued the Children’s Record Review (LIC 857) to the Director during this inspection. In review of children’s records, files contain information including, but not limited to the following: Name, address and telephone number of the child's authorized representative and of relatives or others who can assume responsibility for the child if the authorized representative cannot be reached when necessary.

LPA also issued the Review of Staff records (LIC 859) to the Director during this inspection. The LIC 857 and the LIC 859 documents the children’s and staff files that were reviewed during this inspection. In review of staff records, LPA observed that Staff #1, #4, #5, and #6 do not have immunization records in file. LPA also observed that Staff #1, #4, and #6 do not have certificate of completion in file for the AB1207 mandated reporter training.

Children's roster was reviewed and is current. Sign-in and out sheets and procedures were reviewed. Upon inspecting the sign in sheets for the day, LPA observed that only 34 out of the 41 children present were signed in. Disaster drill log was available, last drill was conducted on 11/13/2019.

Menus are posted one week in advance where it is visible by the child's authorized representative. Menus for the past 30 days are available upon request. Snack/lunch menus were reviewed. Lunch was reviewed for availability, quantity and appropriateness to children in care. Per Director, the facility provides a morning and an afternoon snack. Lunch is provided by the facility or by the parents.

First Aid supplies were observed and kept in the classroom. According to the Director, medication is only administered to a child when accompanied with a doctor's note. Medication is stored in the staff lounge and the staff administers the medications which are stored in a locked cabinet. Per Director, currently there is no child enrolled at this time that requires any medication.

REPORT CONTINUES ON THE NEXT PAGE 3 OF 4

SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2019
LIC809 (FAS) - (06/04)
Page: 3 of 8
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: AGAPE MONTESSORI SCHOOL
FACILITY NUMBER: 198012295
VISIT DATE: 11/22/2019
NARRATIVE
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Incidental Medical Services (IMS). At this time, the facility does not have any children enrolled that require Incidental Medical Services – IMS. However, the facility will provide Incidental Medical Services if needed to children enrolled. 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

LPA advised the Director to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov. UPDATE: Parent’s Rights Poster (with complaint Hotline) and Car Seat Law changes was provided to the Director during this inspection.

A Confidential Names list (LIC811) was provided during this visit.



The following deficiencies are being cited in accordance to Title 22 of the California Code of Regulations and Health & Safety codes. Please refer to LIC809D for documentation of deficiencies cited.

Exit interview conducted with Director Amy Liu. A copy of the Appeal Rights (LIC 9058 FAS 01/16) were given and explained. Director’s signature on this form acknowledges receipt of these rights.

A copy of this report must be provided to the authorized representatives of all currently enrolled children and must also be provided to newly enrolled children for the next 12 months. The report shall be provided no later than the next business day or the next day the child is in care.

The ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC9224) shall be signed and kept in each of the children’s records.

Notice of Site Visit has been posted (LIC9213). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. Copies of this report must be posted for 30 days in a visible location for the authorized representatives of children. END OF REPORT- PAGE 4 OF 4----------------------------

SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2019
LIC809 (FAS) - (06/04)
Page: 4 of 8
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: AGAPE MONTESSORI SCHOOL
FACILITY NUMBER: 198012295
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/22/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/25/2019
Section Cited

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101229 Responsibility for Providing Care and Supervision: (a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time.....Supervision shall include visual observation.
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This requirement is not met as evidenced by LPAs observing during the walk through, LPA observed five children in the hallway hanging their bag packs with no adult present. LPA also observed child #1 was missing from Room A and was later found by Director in Room B. Staff in Room A were not aware that child #1 was missing. This poses an immediate health and safety risk to children in care.
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In addition, Director will also attend Step II operations and record keeping orientation on 12/19/19 from 8:30-1 pm at the MPRO 2nd floor located at 1000 Corporate Center Dr, MP, CA 91754 and will provide LPA a copy of certificate of attendance upon completion.

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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: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 11/22/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/22/2019
LIC809 (FAS) - (06/04)
Page: 5 of 8
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: AGAPE MONTESSORI SCHOOL
FACILITY NUMBER: 198012295
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/22/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/06/2019
Section Cited

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Buildings and Grounds:(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children.
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This requirement is not met as evidenced by LPAs observation of stored cleaning and disenfectant compounds were observed to be accessible to children in Rooms; A, B, C, and E. In addition, RM's A, B, C, D, E and classrooms hallway missing electric outlet covers were observed during this inspection. This poses a potential health and safety risk to children in care.
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Per Director, a staff training/meeting will be held to discuss with staff that electrical outlets are being covered after uncovering them for use and the storage of disinfectants, cleaning solutions, and other items that could pose a danger if accessible to children. Director will provide LPA with a staff agenda/sign in sheet via email by POC due date 12/06/19.
Type B
12/20/2019
Section Cited

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101238-Buildings and Grounds: (a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.
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This requirement is not met as evidenced by LPAs observation of drywall exposure in Room B and on the classroom entrance hallway drywall/metal exposure. In addition, toilet in Room C is out of order. This poses a potential health and safety risk to children 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: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 11/22/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/22/2019
LIC809 (FAS) - (06/04)
Page: 6 of 8
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: AGAPE MONTESSORI SCHOOL
FACILITY NUMBER: 198012295
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/22/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/06/2019
Section Cited

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101229.1-Sign In and Sign Out:
(b) The person who brings the child to, and removes the child from, the center shall sign the child in/out.
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This requirement is not met as evidenced by LPAs observation and interview with Director that there were only 34 out of the 41 children present signed in. This poses a potential health and safety risk to children in care.
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In addition, Director will provided LPA with a copy of the written notification notice that will be given to parent’s regarding Sign in/Sign out procedures via email by POC due date of 12/06/2019.
Type B
12/06/2019
Section Cited

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1596.7995- Employees or volunteers at day care center; immunization requirements; records; exemptions:(c) The day care center shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person’s personnel record that is maintained by the day care center
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This requirement is not met as evidenced by LPAs observation and records review that Staff#1, #4, #5, and #6 were missing immunization records. This poses a potential health and safety risk to children 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: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 11/22/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/22/2019
LIC809 (FAS) - (06/04)
Page: 7 of 8
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: AGAPE MONTESSORI SCHOOL
FACILITY NUMBER: 198012295
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/22/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/06/2019
Section Cited

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1596.8662-Availability of information regarding detecting and reporting child abuse and neglect; training for mandated reporter who is licensed day care provider, administrator, or employee of a licensed child day care facility; proof of completion
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This requirement is not met as evidenced by LPAs observation and records review that Staff#1, #4, #6 were missing proof of completion of AB 1207 mandated reporter training. This poses a potential health and safety risk to children 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: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 11/22/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/22/2019
LIC809 (FAS) - (06/04)
Page: 8 of 8