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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 240402754
Report Date: 11/20/2019
Date Signed: 11/20/2019 03:22:34 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:MERCED MONTESSORI SCHOOLFACILITY NUMBER:
240402754
ADMINISTRATOR:VINEYARD, K/SANTO, MFACILITY TYPE:
850
ADDRESS:436 WEST 21ST STREETTELEPHONE:
(209) 722-9823
CITY:MERCEDSTATE: CAZIP CODE:
95340
CAPACITY:21CENSUS: 17DATE:
11/20/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Ann Mac Donald - OwnerTIME COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analyst, Joseph Pacheco, conducted an unannounced annual/random inspection today. LPA met with Owner, Ann Mac Donald and a tour of the facility was conducted inside and outside. Staff and children were spoken to during visit. The following areas were in compliance during today’s inspection: There are no bodies of water present at this facility. There are no firearms or ammunition allowed on the premises. Disinfectants, hazardous items and medications are inaccessible to children. Storage area for poisons is locked. Furniture and equipment are sufficient, age appropriate and in good repair. The playground equipment and outdoor activity space is maintained and in good condition with adequate cushioning material. Children's toilets, hand washing facilities are sanitary. Rooms are safe and clean. Food preparation area is clean, food and beverages are stored in covered containers at 45 degrees F or less if required, and storage containers for solid waste are covered. Drinking water is available both indoors and outside. Measures are taken to keep facility free of insects and rodents. Staff subject to a criminal record clearance or exemption are associated to the facility. No excluded individuals are present. Teacher-child ratios are maintained and adequate supervision was observed during today’s inspection. First Aid/CPR credentials were reviewed and expire on 1/6/2021. Sign in/sign out sheets are maintained. Children’s records were reviewed to ensure proper forms are located within each child’s file. Staff records contain documentation of education, training, and/or experience. Documentation of required staff immunization's was observed. AB 1207 certification for staff was NOT current. LPA did NOT observe a posted menu.

Hours of operation are Monday through Friday, 7:15am – 5:30pm.

Incidental Medical Services (IMS) policy was discussed. Incidental Medical Services (IMS) are not currently being provided. When any IMS is provided, a Plan for Providing 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

CONTINUED ON LIC809-C
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph PachecoTELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2019
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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: MERCED MONTESSORI SCHOOL
FACILITY NUMBER: 240402754
VISIT DATE: 11/20/2019
NARRATIVE
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LPA provided owner with information regarding providing incidental medical services to children, the CDSS Provider Information Notices (PINs) communication system, and some important resources and information links offered on the CDSS website.

An exit interview was conducted with Director, Ann Mac Donald. A copy of this report must remain in the facility for public review.

Per Chapter 1, Division 12, Title 22 of the California Code of Regulations, the following deficiencies are found (see LIC809-D): Copy of appeal Rights left with owner.

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph PachecoTELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2019
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, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: MERCED MONTESSORI SCHOOL
FACILITY NUMBER: 240402754
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/20/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/20/2019
Section Cited

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On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care…employee of a licensed child day care facility shall complete the mandated reporter training…and shall complete renewal mandated reporter training every two years following the date on which he or she
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completed the initial mandated reporter training. This requirement was not met as evidenced by LPA observation of expired certification in staff files. This is a potential risk to the health, safety or personal rights of children in care.
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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: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph PachecoTELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:
DATE: 11/20/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/20/2019
LIC809 (FAS) - (06/04)
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