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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015582
Report Date: 03/22/2022
Date Signed: 03/22/2022 05:44:51 PM


Document Has Been Signed on 03/22/2022 05:44 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:MONTESSORI SCHOOL OF SAN DIMASFACILITY NUMBER:
198015582
ADMINISTRATOR:FAMEEDA CASSIMFACILITY TYPE:
850
ADDRESS:730 E. FOOTHILL BLVD.TELEPHONE:
(909) 599-7774
CITY:SAN DIMASSTATE: CAZIP CODE:
91773
CAPACITY:73CENSUS: DATE:
03/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:22 PM
MET WITH:Jessy ZakhiaTIME COMPLETED:
05:50 PM
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Licensing Program Analysts (LPAs) Jennifer Hua and Carolyn Tuba conducted an unannounced Annual Random (Required) inspection. LPAs met with Jessy Zakhia, Teacher met us at the front entrance of the school. Director, Fameeda Cassim was not present at the facility and teacher stated she was at a doctor's appointment. LPAs took a self guided tour of the facility. This is a Preschool program with a Toddler Option which consists of 3 classrooms; Room 1 (Toddler), Room 2 (Pre-K), and Room 3 (2's and 3's). Facility operation hours are 7:00a.m. to 5:30p.m. from Monday to Friday.

4:30 PM Director showed-up to the facility to interview and answer questions LPAs had for her.

All areas identified on the Facility Sketch were inspected. The following staff was present during this inspection: RM Pre-K: Staff #1 and Staff #2 with 15 preschoolers; RM Toddler: Staff #3 and Staff #4 with 7 toddlers; RM (2 & 3 years olds): Staff #5 with 9 preschoolers. The following was observed during tour of facility:

PHYSICAL PLANT


Disinfectants, cleaning solutions, and other items that may pose a danger to children, were observed to be inaccessible. Per Director, there are no poisons stored at the facility. Furniture and equipment are in good condition, free of sharp, loose, or pointed parts. All toilets and hand washing sinks are sanitary and are operating properly. All floors are clean and safe.

Drinking water is readily available both indoors and outdoors via water fountains or children have their own water bottles labeled and are taken both inside and outside. The facility was observed to be free of flies, other insects and rodents. Teacher child ratios were observed and staff names recorded. Sign in and out sheets were reviewed. LPAs observed 14 of 15 children signed in for RM Pre-K; 7 of 7 children signed in for RM Toddlers; and 9 of 9 children signed in for RM (2's & 3's).

REPORT CONTINUES ON NEXT PAGE: 1 OF 3
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2022
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


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: MONTESSORI SCHOOL OF SAN DIMAS
FACILITY NUMBER: 198015582
VISIT DATE: 03/22/2022
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Napping equipment and bedding was inspected for good condition, appropriate storage and cleanliness. Storage for children's belongings was inspected. Parents take linens home on Friday and return linens on Monday.

Outdoor playground equipment is in 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. Main Gate leading into the toddler play yard is not in good repair, lower hinge is broken.

FACILITY RECORDS
All individuals present have obtained a criminal record clearance or criminal record exemption. LPAs verified there were three staff trained in CPR and Pediatric First Aid present during this inspection. The name of the child care center director or fully qualified teacher(s) designated to act in the director's absence is on file. Educational background and/or experience for each staff present are on file and were reviewed. LPAs observed AB1207 Mandated Reporter Training. LPAs reviewed files and Director has expired Mandated Report 1/4/2022 and Staff #2 expired mandated reporter certificate on 1/29/2022, Staff #5 missing Mandated Reporter Certificate , Tdap, MMR and 3 units curriculum and Staff #6 Transcripts, Personnel Record complete and need signature, Employee Rights, Tdap, MMR, TB, Health Screening LIC503.

Children's roster was reviewed and is current. Disaster drill log was available, last drill was conducted on 2/2022. Snack menus are not posted because she is not serving snacks due to Covid and parents are providing from home. Snack should be provided for AM and PM for full day care.

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:
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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022
LIC809 (FAS) - (06/04)
Page: 3 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MONTESSORI SCHOOL OF SAN DIMAS
FACILITY NUMBER: 198015582
VISIT DATE: 03/22/2022
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Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA advised the licensee 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) was provided to the licensee during this inspection. PIN 20-01-CCP Required Lead Testing for Drinking Water in Licensed Child Care Centers was provided to Director.

Based on this information, the following deficiencies listed on the attached LIC 809d 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 & safety.



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. Exit interview was conducted with Diana Ramirez, Director, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

END OF REPORT PAGE: 3 OF 3
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4
Document Has Been Signed on 03/22/2022 05:44 PM - It Cannot Be Edited

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: MONTESSORI SCHOOL OF SAN DIMAS
FACILITY NUMBER: 198015582

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/22/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/05/2022
Plan of Correction
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Mandate Reports will be completed by Director, Staff #2, #5 and #6
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4