304270519-7-26-2019-06-CC-CNGN-BEFPXQ-20190726114242

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304270519
Report Date: 07/26/2019
Date Signed: 07/26/2019 11:42:58 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 ON THE LAKE INFANT CENTER		FACILITY NUMBER:	304270519
ADMINISTRATOR:	FITZGERALD, PATRICE		FACILITY TYPE:	830
ADDRESS:	24291 MUIRLANDS, SUITE 4		TELEPHONE:	(949) 855-5630
CITY:	LAKE FOREST	STATE: CA	ZIP CODE:	92630
CAPACITY:	32	CENSUS: 16	DATE:	07/26/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Director, Fitzgerald, Patrice		TIME COMPLETED:	12:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	An inspection was conducted at the facility by Licensing Program Analyst (LPA) Nguyen. The facility file was reviewed prior to this visit. A review of the personnel report on file indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Operating hours are 7:00am 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 16 infants with 8 staff members. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. This is a combination center with a separate infant license. Activity space for infants is separate from other age groups. The items which could pose a danger to children (detergents, cleaning compounds, and medications) were inaccessible to children. The toys, floors and other equipment appeared clean, safe and age appropriate for infants. A baby walker is not allowed on the premises of a child care center. There is sufficient napping equipment. The changing table is within arm’s reach of a sink and appears clean and sanitary. Food prep areas appear clean and sanitary. The facility takes measures to keep the facility free of flies, other inspects, and rodents. Food is properly stored. Bottles and food containers brought from home are properly labeled with name and date. Garbage cans containing solid waste have tight fitting lids. Firearms and other weapons are not allowed or stored on the premises. There is a working smoke detector, carbon monoxide detector and fire extinguisher in the facility. The director stated no children are left without the supervision, including visual supervision, of a teacher at any time. The facility ensures that each infant is never left unattended. The playground is completely fenced and free of hazards. The playground equipment appeared in safe condition. There is sufficient cushioning underneath climbing structures and/or play equipment to absorb falls. Continued on Page 2

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy Nguyen	TELEPHONE: (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 INFANT CENTER	FACILITY NUMBER: 304270519
	VISIT DATE: 07/26/2019

NARRATIVE

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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

Staff files for staff present during LPA’s inspection were reviewed. At least one staff member present possess a current First Aid/CPR certification which expires 01/2021. Personnel files reviewed show infant care teachers have completed 3 units in early childhood education related to the care of infants. Proof of immunization's against pertussis and measles for all employees/volunteers were reviewed for compliance with SB 792. One 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. Two staff members mandated reporter training certificate wasn’t available for LPA to reviewed during today's inspection.

A random sample of ten children’s files were reviewed for a medical assessment and individual feeding plan, and infant needs and services plans. In these areas the review, children’s files were found to be in substantial compliance.

Facility was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov A copy of the 2016 “A Child Care Providers Guild to Safe Sleep” was provided to the facility representative.
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
Spanish: https//www.cdph.ca.gov/programs/SIDS/Documents/ChildCareProvSleepSPAN2011.pdf
AAP:
Continued on Page 3

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy Nguyen	TELEPHONE: (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)

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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 INFANT CENTER	FACILITY NUMBER: 304270519
	VISIT DATE: 07/26/2019

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https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

Based on LPA interview and record reviews the following violations were observed are being cited in accordance with Health and Safety code 1596.8662 (b)(1) and 1597.622(a)(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 Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy Nguyen	TELEPHONE: (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 INFANT CENTER	FACILITY NUMBER: 304270519
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 HSC 1596.8662(b)(1)	1 2 3 4 5 6 7	1596.8662(b)(1) Mandated Reporter Training. A person who, on January 1, 2018, is a licensed child care provider beginning the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Director stated her staff will take the training and the certificates will be sent to LPA by 08/09/19 by mailing to the office.
	8 9 10 11 12 13 14	Based on interview and record reviews, the facility failed to ensure two of the staff members have the mandated reporter training certificates. This poses a potential Health and Safety risk to the children in care.	8 9 10 11 12 13 14
Type B 08/09/2019 Section Cited HSC 1597.622(a)(1)	1 2 3 4 5 6 7	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	1 2 3 4 5 6 7	Director stated she will provide the required immunization record to LPA by 8/09/19 by mailing it to the office.
	8 9 10 11 12 13 14	Based on interview and record reviews, the facility failed to ensure to maintain one her staff immunization record. This poses a potential Health and Safety risk to the children in care	8 9 10 11 12 13 14

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 Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy Nguyen	TELEPHONE: (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)

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