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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016141
Report Date: 05/06/2019
Date Signed: 05/06/2019 04:32:06 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:MONTESSORI SCHOOL OF HACIENDA HEIGHTSFACILITY NUMBER:
198016141
ADMINISTRATOR:ENOKA ATTALEFACILITY TYPE:
850
ADDRESS:15207 E. LOS ROBLES AVENUETELEPHONE:
(626) 968-0500
CITY:HACIENDA HEIGHTSSTATE: CAZIP CODE:
91745
CAPACITY:122CENSUS: 67DATE:
05/06/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Georgina RomeroTIME COMPLETED:
02:00 PM
NARRATIVE
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Random site inspection was conducted on this date by Licensing Program Analyst, Jennifer Hua, who met with Office Manager, Georgina Romero, who guided analyst on a complete tour of the facility. Director/licensee arrived during visit. There are 4 classrooms designated for the preschool program.

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/outdoor drinking water was observed.

Outdoor 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.

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. Facility do not provide lunch.

Teacher child ratios were observed and staff names recorded. Care and supervision was evaluated to determine if the basic needs of children are met. Sign-in and out sheets and procedures were reviewed. Personal Rights of children were observed by LPA. Staff and Children’s Records were reviewed. Criminal Record Clearances were reviewed for adults. Licensee and staff are current in Pediatric First Aid/CPR as observed on the certificates. Card expires on 5/14/20

Report continues to the next page.
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2019
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: MONTESSORI SCHOOL OF HACIENDA HEIGHTS
FACILITY NUMBER: 198016141
VISIT DATE: 05/06/2019
NARRATIVE
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Staff have completed the Mandated Reporter Training on department website at http://www.mandatedreporterca.com/ certificate observed in staff files. Licensee was informed certificate must be renew every 2 years.

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. MOST RECENT EXEMPTION REGULATIONS DISCUSSED.

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.

Deficiencies cited on attached 809D.

An exit interview conducted with office manager and licensee, copy of report given. Licensee/appeal rights provided and explained


Notice of Site Visit Form was provided and explained. The notice shall be posted 30 or a civil penalty of $100 will be assessed.
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2019
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: MONTESSORI SCHOOL OF HACIENDA HEIGHTS
FACILITY NUMBER: 198016141
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/06/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/07/2019
Section Cited
CCR
101229.1(b)
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Sign In and Sign Out. The person who brings the child to, and removes the child from, the center shall sign the child in/out. This requirement is not met as evidenced by: Director & LPA reviewed sign in sheets and counted 16 children were not signed in. This poses a potential risk to the health and safety of children in care.
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Per licensee, will assign staff to monitor parent sign in student and send letter to all parents and will also remind parents in the news letter and will also post sign to remind parents. will submit proof to LPA by the POC due date of 5/7/19.
Type B
06/06/2019
Section Cited
HSC
1596.7995(c)
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Required Immunizations. Effective 9/1/16, all staff and volunteers are required to maintain proof of influenza, Pertussis and Measles immuniations on file. This requirement is not met as evidenced by: 3 staff files lack record. See form 811 for reference. This poses a potential risk to the health & safety of children in care care.
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Per licensee, will maintain copy and submit copy to LPA by the POC due date of 6/6/19.
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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: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3