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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300600679
Report Date: 12/09/2019
Date Signed: 12/09/2019 11:46:49 AM

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: 3DATE:
12/09/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Shirani Perera-OwnerTIME COMPLETED:
12:15 PM
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An unannounced inspection for a case management of the facility was conducted by Licensing Program Analyst (LPA) Andrea Taylor to verify compliance with Title 22. A review of staff records indicates all facility staff or individuals who require caregiver background checks have received a criminal record clearance or exemption and a child abuse index clearance except for two new staff Astrid Abeyratne and Trevor Luff. Astrid Abeyratne had clearances associated to other licensed facilities but the clearances are now inactive. Trevor does not have any clearances associated to any facilities. Both Astrid Abeyratne and Trevor Luff will need to go to have LiveScan completed. LPA Taylor printed LiveScan form and provided the form to Ms. Perera.
LPA Taylor is issuing a citation for Astrid Abeyratne not having criminal background clearances associated to the facility. Ms. Perera states Trevor Luff only works at the facility one hour one day a week (Thursdays) after school to teach dance classes for this reason LPA Taylor is advising Ms. Perera to have Trevor Luff get LiveScan clearances completed prior to allowing him to enter the facility.

LPA observed a new teacher in the preschool classroom along with three children. After reviewing the three children's emergency information in their files LPA discovered two of the boys are 6 years old and one of the boys is 3 years old. During the inspection on 9/24/19 the Licensee was cited for co-mingling children. During the inspection on 9/24/19 and an Office visit on 10/1/19 the issue of co-mingling was discussed with Ms. Perera. The co-mingling during today's inspection is a repeat violation and a civil penalty for a repeat violation is being assessed today.

LPA Taylor requested to review the file for new employee Astrid Abeyratne. Ms. Perera did not have a file for Astrid Abeyratne. LPA verified on Department's system Astrid Abeyratne has worked at another licensed facility as a fully qualified teacher.
Since Ms. Perera did not have the file for Astrid Abeyratne a citation for not maintaining a complete file for employees will be cited.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (714) 658-6048
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2019
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 4
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: 12/09/2019
NARRATIVE
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In the areas that were evaluated, the facility was not in compliance and violations, in accordance with California Code of Regulations, Limitations and Condition of License 101161(a), 101170(e) Criminal Record Clearance and 101217(a) Personnel Records, is being cited on the attached LIC 809D.

Exit interview was conducted. Report reviewed and discussed. Notice of Site Visit was posted during the visit. Appeal rights provided and explained. The director was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. Licensee was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov

The facility representative was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. Failure to post will result in Civil Penalties of $100.00. The “Notice of Site Visit” must be posted on or adjacent to the door. Failure to post Type A reports for 30 days will result in a Civil Penalty of $100.00

If the facility receives a Type A violations, the licensee shall post and provide copies of the report to parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days, and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file.
In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (714) 658-6048
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: 12/09/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
12/09/2019
Section Cited

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Limitations on Capacity and Ambulatory Status: The licensee shall not exceed the conditions, limitations and capacity specified in the license. The above requirement is not met by LPA observing 2 school age children with 1 preschool age children in the same classroom
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This is an immediate risk to Health and Safety to children in care. This is a repeated citation issued earlier in 2006/ 2010 /2014, 2016 and
on 9/24/19.
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Type A
12/09/2019
Section Cited

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All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:(1) Obtain a California clearance or a criminal record exemption as required by the Department
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The above requirement is not met as verified on facility criminal background clearance list.
Astrid Abeyratne is not associated to the facility and has inactive clearance in the Departments system.
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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: Andrea TaylorTELEPHONE: (714) 658-6048
LICENSING EVALUATOR SIGNATURE:
DATE: 12/09/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: 12/09/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/16/2019
Section Cited

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Personnel Record: The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:(1) Employee's full name.
(2) Driver's license number if the employee is to transport children, etc...
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6) Documentation of the educational background, training and/or experience specified in this chapter. etc... The above requirement is not met as evidenced by the license failing to have a file for new employe(e Astrid Abeyratne. This is a potential risk to the health and safety 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: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (714) 658-6048
LICENSING EVALUATOR SIGNATURE:
DATE: 12/09/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4