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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019169
Report Date: 05/23/2022
Date Signed: 05/23/2022 11:01:49 AM


Document Has Been Signed on 05/23/2022 11:01 AM - 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:BAXTER MONTESSORI SCHOOLFACILITY NUMBER:
198019169
ADMINISTRATOR:LI ZHOUFACILITY TYPE:
850
ADDRESS:2101 ECHO PARK AVE.TELEPHONE:
(310) 663-6053
CITY:LOS ANGELESSTATE: CAZIP CODE:
90026
CAPACITY:60CENSUS: 27DATE:
05/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Li Zhou TIME COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA) Judy Mora conducted an unannounced Required 1 Year inspection. LPA met with designated facility Director, Li Zhou. This is a preschool age program licensed for 60 children which operates Monday – Friday from 8:30 AM – 5:00 PM. Per the Director there are 32 children enrolled. Covid Precautionary Measures are being conducted at the main entrance of the facility.

At approximately 9:00 AM LPA Mora began facility tour with Director. All areas identified on the facility sketch were inspected. LPA observed 21 children with 03 staff in the Big Main Room. The classroom downstairs near entrance of the facility is not currently being used. Teacher-child ratios were observed to be in accordance with Title 22 regulations. The Licensee is within the conditions, limitations, and capacity specified on the license. Staff names were recorded. Criminal Record Clearances were reviewed. During this inspection, all children were observed to be under visual supervision of a teacher at all times.

LPA observed required forms to be posted on the Parent Board located near entrance of facility. LPA observed the following: Facility License, LIC 613A Personal Rights, PUB 269 Child Car Seat Poster, PUB 369 Notification of Parent's Rights, and LIC 610 Emergency Disaster Plan. LIC 9148 Earthquake Preparedness and Verification of Disaster and Fire Drills were reviewed.

LPA observed the facility to be clean, safe, sanitary and in good repair. Furniture and equipment was inspected for good repair, free of sharp, loose, or pointed parts. All surfaces and materials accessible to children, including toys, are toxic free. All toilets and hand washing facilities are in safe and sanitary operating conditions. At this time, the Director’s office is used as an isolation area. 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.

REPORT CONTINUES ON NEXT PAGE*
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2022
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: BAXTER MONTESSORI SCHOOL
FACILITY NUMBER: 198019169
VISIT DATE: 05/23/2022
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Due to Covid, parents provide all food and snack items for children. LPA advised Director to begin to incorporate snacks back into the program as it is a requirement for full day programs. Director agreed. During this time, children bring in their own water bottles. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are stored in an area inaccessible to children. Storage areas for poisons are locked. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. Transportation services are not provided.

Outdoor play equipment was observed to be in good condition, free of sharp, loose or pointed parts. LPA observed age appropriate toys and equipment. Outdoor activity space surface is maintained in a safe condition as is free of hazards. LPA advised Director to dispose of any unused and/or damaged items in the yard. The Director states that there are no bodies of water on the premises and LPA did not observe any bodies of water during this. Director states there are no weapons or firearms on the premises.

Sign in and 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 observed all children present to be signed in.


Staff Records were reviewed to ensure the following are present: Staff qualifications, proof of immunization’s, current Pediatric First Aid & CPR certification, TB Clearance or Risk Assessment, LIC 503 Health Screening Report, LIC 508 Criminal Record Statement, LIC 9108 Statement Acknowledging Requirement to Report Child Abuse, Mandated Reporter Certificate and the LIC 9052 Notice of Employee’s Rights. At this time, no staff have a current Pediatric First Aid & CPR certification.



Children’s Records were reviewed to ensure that the following are present: LIC 613A Personal Rights, Admission Agreement, LIC 700 Identification and Emergency form, LIC 701 Physician’s Report, LIC 995 Notification of Parent’s Rights, LIC 627 Consent for Emergency Medical Treatment and Immunization Record.



*REPORT CONTINUES ON NEXT PAGE

SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2022
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: BAXTER MONTESSORI SCHOOL
FACILITY NUMBER: 198019169
VISIT DATE: 05/23/2022
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This facility provides Incidental Medical Services – IMS. Per Director, there are no children on medication. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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

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/process.

Director was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Director, Li Zhou.

*END OF REPORT

SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2022
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 05/23/2022 11:01 AM - 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: BAXTER MONTESSORI SCHOOL
FACILITY NUMBER: 198019169

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/23/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(f)
Personnel Requirements
(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on staff file review, the licensee did not comply with the section cited above in 1 of 1, LPA observed that no staff present have a current Pediatric First Aid/CPR certification which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/23/2022
Plan of Correction
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Director states training will be completed and LPA will be sent a copy of the certification.
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: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2022
LIC809 (FAS) - (06/04)
Page: 4 of 5