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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300606752
Report Date: 07/26/2019
Date Signed: 07/26/2019 01:02:22 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 ON THE LAKEFACILITY NUMBER:
300606752
ADMINISTRATOR:FITZGERALD, PATRICEFACILITY TYPE:
850
ADDRESS:24291 MUIRLANDS, SUITES 1 & 2TELEPHONE:
(949) 855-5630
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY:77CENSUS: 53DATE:
07/26/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Director, Patrice FitzgeraldTIME COMPLETED:
01:45 PM
NARRATIVE
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An inspection was conducted at the facility by Licensing Program Analyst (LPA) Nguyen. The facility file was reviewed prior to this inspection. 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. Operating hours are 6:30am to 6:00pm, Mon-Fri. Upon arrival LPA met with Director, Patrice, Fitzgerald. The facility was toured inside and outside, and the floor and yard plan were verified. LPA observed 53 preschool age children with 9 staff members. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios.

LPA confirmed with facility representative that firearms/weapons are not allowed or stored on premises. The facility appeared clean and orderly. The items which could pose a danger to children (disinfectants and cleaning solutions) were stored out of the reach of children. All materials and surfaces accessible to children are toxic free. Medications are in a safe place inaccessible to children. The children’s bathrooms were observed to be in safe and sanitary operating conditions.

All floors are clean and safe. Furniture and equipment are in good condition, free of sharp, loose or pointed parts. Food is prepared on site, snacks are provided. Food prep areas appear clean and sanitary. Food is properly stored. On site food prep area is free from hazards. Solid waste receptacles have a tight-fitting cover and are in good repair. Children nap on cots/mats, and bedding is to be laundered at the facility weekly or as needed.



There is drinking water available to children both indoors and outdoors. A current menu is posted is a prominent location viewable by an authorized representative. The facility has a working smoke detector, carbon monoxide detector, and fire extinguisher that meet statutory requirements.

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SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy NguyenTELEPHONE: (714) 703-2834
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2019
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MONTESSORI ON THE LAKE
FACILITY NUMBER: 300606752
VISIT DATE: 07/26/2019
NARRATIVE
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Based on LPA interview and record reviews the following violations were observed are being cited in accordance with California Code of Regulations, Title 22, Division 12, Section 101229.1(b) and Health and Safety code 1596.8662 (b)(1). Please refer to attached 809D for documentation of deficiencies.

Exit interview was conducted with Director, Patrice Fitzgerald. Report reviewed and discussed. Notice of Site Visit was posted during the visit. 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. Appeal rights provided and explained. The facility representative was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. Facility representative was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov

SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy NguyenTELEPHONE: (714) 703-2834
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2019
LIC809 (FAS) - (06/04)
Page: 4 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 ON THE LAKE
FACILITY NUMBER: 300606752
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/26/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/09/2019
Section Cited
CCR
101229.1(b)
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101229.1 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 by evidenced by:
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Director stated will send LPA a statement of new sign in and out procedures to ensure all children present are signed in and out. Plan of correction due by 08/09/19 by mailing to the office.
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Based on LPA reviewing the sign in records, there were at least 5 children didn't get sign in today. This poses a potential risk to the health and safety of children in care.
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Type B
08/09/2019
Section Cited
HSC
1597.622(a)(1)
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1597.622(a)(1) Employee and Volunteer Immunization (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles...
This requirement is not met as evidenced by
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Director stated she will provide the required immunization record from her staff to LPA by 08/09/19 by mailing it to the office.
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Based on interview and record reviews, the facility failed to ensure to maintain a staff member immunization record. This poses a potential Health and Safety risk to the 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: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy NguyenTELEPHONE: (714) 703-2834
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2019
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 ON THE LAKE
FACILITY NUMBER: 300606752
VISIT DATE: 07/26/2019
NARRATIVE
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The playground was completely fenced. The playground equipment appeared in safe condition, and play area is free from hazards. There are sufficient cushioning underneath climbing structures and/or play equipment to absorb falls. The facility has conducted an emergency drill within the past six months.

Sign in/out procedure was reviewed for compliance. At least 5 children were missing the parent’s signatures during today’s inspection. A random sample of ten children’s sign/in out sheets for two dates was reviewed. The person who signs the child in and out uses their full legal signature and records the time of the day. The child is signed in and out for the person responsible for the child. A random sample of ten children's files were reviewed for an admission agreement and found to be in substantial compliance.

Staff files for staff present during today’s inspection were reviewed for appropriate documentation of education credits. At least one staff member present possesses current CPR/First Aid certifications, which expires 01/2021. Proof of immunization's against influenza (or written decline), pertussis and measles for all employees/volunteers were reviewed for compliance with SB 792. One out of nine staff member was missing proof of immunization. Beginning March 31, 2018, Health and Safety Code 1596.8662 requires all directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years, per A.B. 1207. Proof of completion as required by AB 1207 was observed in staff files.

This facility provides Incidental Medical Services -IMS. LPA reviewed storage of medication, equipment/supplies, and reviewed children's, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (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

Facility representative was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov


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SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy NguyenTELEPHONE: (714) 703-2834
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4