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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300600679
Report Date: 09/20/2019
Date Signed: 09/20/2019 04:05:39 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:MONTESSORI HOUSE OF CHILDRENFACILITY NUMBER:
300600679
ADMINISTRATOR:SHIRANI PERERAFACILITY TYPE:
850
ADDRESS:1239 SOUTH MAGNOLIATELEPHONE:
(714) 761-3109
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:26CENSUS: 8DATE:
09/20/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Director Shirani Perera TIME COMPLETED:
04:25 PM
NARRATIVE
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Licensing Program Analyst conducted an unannounced Case -Management Deficiencies inspection following the Type A violations issued during the annual inspection conducted on 9/19/2019.

Director was observed to be in the classroom along with the assistant providing care and supervision to eight preschool age children in the identified Pre-school classroom.

No changes were observed on site upon arrival. Play yard still is open with working sharp tools/ wooden planks/ paint/ wire mesh laying around without any barrier or hazard tape making the area inaccessible to children. Per Director the children do not go in the area.

But shortly , LPA was notified by the Director that the handy man was placing the barrier tapes across the play yard making the yard completely inaccessible to children.( Picture taken) and also Director informed another Handy man is on his way to complete the assigned pending work.
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LPA also handed in person Noncompliance letter from the Regional Manager which was acknowledged by the Licensee.

LPA received the following documents from the Licensee: Copy of Private school Affidavit Confirmation/ Updated Facility sketch/Emergency Disaster plan . LIC 500 remains current - no staff changes.

Deficiency cited per Title 22.

Type A deficiency ( CCR: 101238(a) cleared on today's visit.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2019
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MONTESSORI HOUSE OF CHILDREN
FACILITY NUMBER: 300600679
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/20/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/23/2019
Section Cited

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Reporting requirements: Any changes in the plan of operation that affect services to children.
The above requirement is not met by evidence, where the Licensee failed to notifiy the dept for the Change in Operating hours . The Center has new operating hours
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This is a potential risk to H&S to 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: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:
DATE: 09/20/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/20/2019
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MONTESSORI HOUSE OF CHILDREN
FACILITY NUMBER: 300600679
VISIT DATE: 09/20/2019
NARRATIVE
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Upon receipt, Director Sharani Perara posted the Notice of Site Visit. The Notice of Site Visit shall be posted for thirty (30) consecutive days.

Failure to maintain posting as required will result in a $100 civil penalty.

An exit interview has been conducted with, and a copy of this report has been signed by and provided to Director.

Appeal Rights provided and explained to the Director.

SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2019
LIC809 (FAS) - (06/04)
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