198018405-5-14-2024-33-CC-LBAK-D59TU2-20240514150137

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198018405
Report Date: 05/14/2024
Date Signed: 05/14/2024 03:02:11 PM

Document Has Been Signed on 05/14/2024 03:02 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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	KEYSTONE MONTESSORI PRESCHOOL		FACILITY NUMBER:	198018405
ADMINISTRATOR:	BHAGYA WIJEWARDANE		FACILITY TYPE:	850
ADDRESS:	7056 WASHINGTON AVE.		TELEPHONE:	(562) 303-7273
CITY:	WHITTIER	STATE: CA	ZIP CODE:	90602
CAPACITY:	53	CENSUS: 20	DATE:	05/14/2024
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Director Bhagya Wijewardane		TIME COMPLETED:	03:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 5/14/24, Licensing Program Analyst (LPA) Lilli Babcock conducted an unannounced annual inspection. A Covid risk assessment was conducted. LPA met with Lead Teacher, Nohelly Rios, to whom the reason for the visit was explained. Director arrived at 10:17 am and guided LPA on a tour of the facility. This is a preschool program which is currently licensed for a capacity of 53 children and operates Monday – Friday from 7:00 AM – 6:00 PM. Per Director there are 34 children enrolled. Census was taken upon arrival and the following staff and children were observed by LPA to be present: Navigators Room: Staff #1 with 10 children, Adventurers Room: Staff #2 with 5 children, Beginners (Toddler) Room: Staff #3 with 5 children. Teacher-child ratios were observed to be in accordance with Title 22 Regulations. Staff names were recorded. LPA observed Staff #2 did not have criminal record clearance in the Department’s Guardian fingerprint clearance database. Director also checked the Guardian database during the visit and determined Staff #2 did not have fingerprint clearance on this day. Director stated she submitted a clearance transfer request to the Department, however it has been determined that Staff #2 will need to be re-fingerprinted. All children were observed by LPA to be under supervision, including visual supervision, of a teacher at all times. All areas identified on the Facility Sketch were inspected and the following was observed: All indoor classrooms were inspected to ensure that furniture and equipment are age-appropriate and in good repair, and the floors have a surface that are safe and clean. Napping equipment including cots and bedding were inspected for good condition and appropriate storage. Per Director, children take their Page 1 of 6

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Lilli Babcock	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024

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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Document Has Been Signed on 05/14/2024 03:02 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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KEYSTONE MONTESSORI PRESCHOOL	FACILITY NUMBER: 198018405
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/14/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

HSC

1596.871(c)(1)(A)

Administration of Child Day Care Licensing

Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above in 1 out of 4 staff without fingerprint clearance which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 05/15/2024
	Plan of Correction
1 2 3 4	Director will have Staff #2 obtain a livescan (fingerprint) and will check fingerprint status is clear prior to having the Staff #2 return to the classroom.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Brandi VanOosten	TELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Lilli Babcock	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024

LIC809 (FAS) - (06/04)

Page: 2 of 8

Document Has Been Signed on 05/14/2024 03:02 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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KEYSTONE MONTESSORI PRESCHOOL	FACILITY NUMBER: 198018405
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/14/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101238.2(d)(1)

Outdoor Activity Space

(d) The surface of the outdoor activity space shall be maintained: (1) In a safe condition for the activities planned. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in 1 of 1 outdoor spaces with holes in the outdoor padding which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/14/2024
	Plan of Correction
1 2 3 4	Director states the facility will have the rubber padding repaired in the holes in the outdoor play yard.

Type B

Section Cited

CCR

101229.1(b)

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. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review the licensee did not comply with the section cited above in 13 of 13 days of sign in/out sheets between 4/24/24 - 5/13/24 where at least one child on each day that was signed in but not signed out of the facility which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/14/2024
	Plan of Correction
1 2 3 4	Director states facility will give each parent a written notice stating the importance of signing their child in and out daily including their full signature. Director states staff will remind parents to sign in and out on a daily basis. Director will also meet with staff regarding the sign in and out procedure and will have staff sign that they are aware of the procedure.

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: Brandi VanOosten	TELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Lilli Babcock	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024

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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KEYSTONE MONTESSORI PRESCHOOL	FACILITY NUMBER: 198018405
	VISIT DATE: 05/14/2024

NARRATIVE

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bedding home to wash weekly. Storage for children's belongings were inspected and LPA observed children have their own labeled cubbies to store their belongings. Children bring water bottles from home and are allowed to drink freely at any time. Water bottles are refilled on demand from a water filtration spout on the sink.

LPA observed toys and materials for children in the classrooms. Age-appropriate sinks and toilets were inspected for availability and good repair in restrooms used by children. Per Director, the office is used as an isolation area and ill children use the staff restroom. Per Director, staff provide 100% supervision when ill child is using the isolation room and/or restroom, and parents are contacted immediately when children are determined to be ill and staff are ensuring that children with obvious symptoms of illness are not being accepted.

Food menus were reviewed to ensure that they are being posted at least one week in advance and visible to an authorized representative. Menus for the past 30 days are available upon request. The facility provides breakfast, lunch, and AM/PM snack. All kitchen, food preparation, and food storage areas are clean, free of litter, rubbish, and rodents, and other vermin. All food is protected from contamination, and LPA inspected that any contaminated food is discarded immediately. LPA inspected food to be in good quantity and quality on this day.

All storage containers for solid waste, including moveable bins, have tight fitting covers on and are in good repair. Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. Director states that there are no poisons or firearms on the premises.

Per Director there are no children at the facility that currently use medications. First aid kits were located. Telephone service, heating, lighting, and ventilation were evaluated. Per Director, preschool

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SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Lilli Babcock	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024

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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KEYSTONE MONTESSORI PRESCHOOL	FACILITY NUMBER: 198018405
	VISIT DATE: 05/14/2024

NARRATIVE

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has their own land line. LPA observed the facility to have operable carbon monoxide and smoke detectors on this day.

The facility has an outdoor play area that is fully fenced. Outdoor playground equipment is free of sharp, loose, or pointed parts. LPA observed the surface of the outdoor activity space has multiple holes where the padding under and around the play structure has eroded. Director stated they are working on repairing the holes in the outdoor padding and the facility is hoping to paint the play structure in the near future. There is adequate shade in the play yard. There are safe toys, play equipment and materials observed for children outside on playground. Availability of outdoor drinking water was observed. Per Director, children bring their water bottles with them each time the classroom goes outdoors.

Sign-in and Sign-out sheets were reviewed to ensure that the person who signs the child in and out uses their full legal signature and records the time of the day. LPA reviewed sign in/out sheets for the dates of 4/24/24 – 5/13/24 and LPA observed at least one child was signed in but not signed out of the facility on each day during that time period. LPA reviewed facility roster and Disaster Drill log. Last drill was conducted on 3/15/24. LPA observed all required posted forms to be posted in the hallway leading to the classrooms.

Staff Records and Children’s Records were reviewed. LPA observed children’s files reviewed to be complete. Inspection of required forms were made. Children’s files reviewed 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.

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SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Lilli Babcock	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024

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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KEYSTONE MONTESSORI PRESCHOOL	FACILITY NUMBER: 198018405
	VISIT DATE: 05/14/2024

NARRATIVE

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LPA reviewed staff files, including Health Screenings. LPA observed all personnel to be in good health and are physically and mentally capable of performing assigned tasks. LPA observed staff to have current Mandated Reporter Training (AB1207), and staff immunization records (Influenza, Measles, and Pertussis) were observed to be complete.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection- process.

Facility Representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.
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SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Lilli Babcock	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024

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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KEYSTONE MONTESSORI PRESCHOOL	FACILITY NUMBER: 198018405
	VISIT DATE: 05/14/2024

NARRATIVE

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LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care- licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/. PIN 22-05-CCP

Facility Representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Based on LPA’s observations and record review, the following deficiencies listed on the attached LIC 809D (deficiency page) 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 and safety.

LPA Lilli Babcock informed facility representative Bhagya Wijewardane, that this report dated 5/14/24 documents 1 Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

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SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Lilli Babcock	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024

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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KEYSTONE MONTESSORI PRESCHOOL	FACILITY NUMBER: 198018405
	VISIT DATE: 05/14/2024

NARRATIVE

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Also, LPA Lilli Babcock informed the facility representative to provide a copy of this licensing report dated 5/14/24 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

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

An exit interview was conducted, and the report was reviewed with the facility representative, Bhagya Wijewardane.

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SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Lilli Babcock	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024

LIC809 (FAS) - (06/04)

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