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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015361
Report Date: 01/25/2023
Date Signed: 01/25/2023 03:13:06 PM


Document Has Been Signed on 01/25/2023 03:13 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:HACIENDA MONTESSORI ACADEMYFACILITY NUMBER:
198015361
ADMINISTRATOR:MARIA ROSSFACILITY TYPE:
850
ADDRESS:15694 TETLEY STREETTELEPHONE:
(626) 333-5566
CITY:HACIENDA HEIGHTSSTATE: CAZIP CODE:
91745
CAPACITY:60CENSUS: 30DATE:
01/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Brandi KegariceTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Jennifer Hua conducted an unannounced Required - 1 year inspection. LPA met with Director Brandi Kegarice. A COVID-19 risk assessment was conducted prior to entry to the facility. LPA provided a copy of the LIC 125 Entrance Checklist to facilitate the inspection. This is a preschool program. Business hours are from Monday to Friday, 7:00 AM to 6:00 PM.

LPA was guided to a facility tour by Director at 1:10pm . All areas identified on the Facility Sketch were inspected. There are 5 classrooms for the preschool program: The following were observed:
  • Classroom #1 - 11 children with 1 staff.
  • Classroom #2A - 0 children
  • Classroom #2B - 14 children with 3 staff.
  • Classroom #3 - 5 children with 1 staff
  • Classroom #4 - Currently closed

The facility was observed to be within the license capacity and limitations. Children's roster was reviewed. Sign-In and Sign-Out sheets were reviewed. SIgn in/out are done on an IPAD and can be printed as needed

The following were observed during the tour of the facility:
Furniture and equipment were inspected for age appropriateness and good repair, telephone service (land line in the office), heating, lighting and ventilation were evaluated. All floors were observed to be clean and safe. All materials accessible to children were observed to be toxic free. Per Director, there were no firearms stored on the premises and no pools or bodies of water. Children have their own cubby to store their belongings. Cots are stacked. Blankets/sheets are sent home to be wash every Friday. Per Director, the isolation area is in the office. 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 the classroom. First Aid supplies were in every classroom.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:
DATE: 01/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/25/2023
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: HACIENDA MONTESSORI ACADEMY
FACILITY NUMBER: 198015361
VISIT DATE: 01/25/2023
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Disinfectants, cleaning solutions, and other items that are dangerous to children were inaccessible. Carbon monoxide and smoke detectors were observed in the classrooms. 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 have tight-fitting covers that are kept on, and in good repair. Trash cans used to discard food have tight fitting lids. Per director, breakfast, AM/PM snacks and lunch are provided by the facility. Menu was observed to be posted for the month. Drills were conducted on 12/22/22.

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. The outdoor surface is cushioned with wood chips that absorbs a fall. There is adequate shade in the play yard. Per director, outdoor drinking water will be brought when children are outside. LPA advised that no children shall be left without the supervision of a teacher at any time.

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. The review of Staff records was documented on the LIC 859. Staff present have proof of the AB 1207 Mandated Reporter Training certificate on file. Staff present have proof against TB, measles, pertussis, and influenza.



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
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023
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
VISIT DATE: 01/25/2023
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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/tion-process.

NOTE: During this visit, copy of Lead documents received: Sketch, LIC 9275, LIC 9276 and copy of testing from Enthalpy Analytical that was conducted on 1/25/23.

There were no deficiencies cited during today’s inspection.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Director.

SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3