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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015361
Report Date: 10/10/2019
Date Signed: 10/10/2019 12:01:52 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:HACIENDA MONTESSORI ACADEMYFACILITY NUMBER:
198015361
ADMINISTRATOR:MARIA ROSSFACILITY TYPE:
850
ADDRESS:15694 TETLEY STREETTELEPHONE:
(626) 333-5566
CITY:HACIENDA HEIGHTSSTATE: CAZIP CODE:
91745
CAPACITY:49CENSUS: 30DATE:
10/10/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
07:54 AM
MET WITH:Melody StephensTIME COMPLETED:
12:10 PM
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An unannounced Random and Capacity Increase inspection was conducted by Licensing Program Analyst, Jennifer Hua. LPA met with head teacher Melody Stephens who is also acting director. The facility currently does not have a director for over 30 days. Per licensee, is actively seeking to hire a director. LPA informed acting director the purpose of the visit. LPA was allowed to tour the facility. LPA toured the facility with Head teacher and measurements of the classrooms and the playground were taken. Licensee is seeking to increase capacity from 49 to 68. There are a total of 5 classrooms: Rooms #1, 2A, 2B, 3 and 4 (new room). The program operates Monday - Friday from 7am-6pm.

Rooms identified on facility sketch were inspected Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Napping equipment and bedding were inspected. Storage for children's belongings and an isolation area with a sink, toilet, and mats/cots was inspected. Age appropriate sinks and toilets were inspected for availability and good repair. General sanitation was observed. Availability of indoor drinking water was observed.

Outdoor area and 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. The chain link fencing along the driveway is less than 4 feet high and sections of the fencing is in disrepair - it's wobbly and the metal pole is not connected.

Snack/lunch menus were reviewed. Food and snacks were reviewed for availability, quantity and appropriateness to children in care. Food preparation areas were toured for safety, cleanliness. A review of cleaning and food supply storage areas was made.

Teacher child ratios were observed and staff names recorded. Care and supervision was evaluated to determine if the basic needs of children are met.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 513-3793
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019
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 3
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: HACIENDA MONTESSORI ACADEMY
FACILITY NUMBER: 198015361
VISIT DATE: 10/10/2019
NARRATIVE
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Staff and children records were reviewed for completeness including but not limited to Criminal Record Clearances for adults, Director Qualifications and verification of CPR/First Aid and health preventive practices documentation. Review of required forms was made. Reporting requirements discussed and explained.
A review of all facility staff or other individuals who require caregiver background checks was conducted on this date to determine if they have received criminal record and child abuse index clearances or exemptions and/or have provided proof of submission of finger prints to DOJ, FBI and CAIC.
Incidental Medical Services - (IMS) was discussed. For IMS information see Evaluator Manual - Regulation and 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
INTERNET ADDRESS: http://www.ccld.ca.gov – To access licensing forms, updates and Title 22.
After a complete inspection of the facility, the following deficiencies were observed according to California Code of Regulations Title 22 Division 12 during today's visit as indicated on the page that follows.

Fire clearance has been approved.

Based on measurements taken today and the number of sinks and toilets for children use, the maximum capacity facility shall be approved is 60 capacity.

Capacity increase shall be approved once deficiencies are corrected. Contact LPA once corrections are completed. A follow up inspection will be conducted to ensure corrections are done.

An exit interview conducted with Melody Stephens. Copy of report given. Notice of Site Visit form was posted and shall be posted for 30 days or a civil penalty of $100 will be assessed. Appeals rights provided and explained.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 513-3793
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: HACIENDA MONTESSORI ACADEMY
FACILITY NUMBER: 198015361
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/10/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/11/2019
Section Cited

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Outdoor Activity Space. The playground shall be enclosed by a fence to protect children and to keep them in the outdoor activity area. The fence shall be at least four feet high. The requirement is not met as evidenced by: LPA measured the chain link fence along the driveway, the fence is measured at 3 feet 9 inches high. Section of the fence is wobbly
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and metal pole is lose. The poses a potential risk to the health and safety of children in care.
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Type B
11/11/2019
Section Cited

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Director Qualifications and Duties. If the child care center director is absent for more than 30 consecutive calendar days, the substitute director shall meet the qualifications of a director. The requirement is not met as evidenced by: Lack transcript for the administration/supervison course.

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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: Ana ChicoTELEPHONE: (323) 513-3793
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:
DATE: 10/10/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/10/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3