304370538-7-23-2019-06-CC-WPOT-BECRHJ-20190723130226

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304370538
Report Date: 07/23/2019
Date Signed: 07/23/2019 01:02:36 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 CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	304370538
ADMINISTRATOR:	WIJCIECHOWSKI, CYNTHIA		FACILITY TYPE:	850
ADDRESS:	5702 CLARK DRIVE		TELEPHONE:	(714) 377-5779
CITY:	HUNTINGTON BEACH	STATE: CA	ZIP CODE:	92649
CAPACITY:	90	CENSUS: 41	DATE:	07/23/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Cynthia Wojciechowski, Director and Ann Vu, Administrator		TIME COMPLETED:	01:15 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) Port. 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 7:00 AM to 6:00 PM, Monday through Friday. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. LPA observed 4 toddlers and 1 staff member in room 20, 7 preschool age children and 2 staff members in Room 20 (divided from toddlers by a baby gate), 11 preschool age children and 1 staff member in Rom 21, 10 preschool age children and 2 staff member in Room 22, and 9 preschool age children and 1 staff member in Room 23. The toddler component indoor and outdoor space is physically separate from the preschool component. The facility was toured inside and outside and the floor and yard plan were verified. The facility representative stated there is no bodies of water onsite. 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. Poisons/Hazardous Items are locked in the janitor's closet. 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. Children nap on cots/mats, and bedding is sent home weekly to be laundered by parents. All floors are clean and safe. Furniture and equipment are in good condition, free of sharp, loose or pointed parts. Lunch is brought by each child from home and snacks are provided by the facility. Food prep areas appear clean and sanitary. Food is properly stored. Solid waste receptacles have a tight-fitting cover and are in good repair. Page 1 of 3 (Continued on Page 2)

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy Port	TELEPHONE: (714) 703-2815
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2019

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 CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 304370538
	VISIT DATE: 07/23/2019

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
26
27
28
29
30
31
32

Page 3 of 3

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. A copy of the Summer 2019 Quarterly Update and a copy of the Department of Social Services Lead Information brochure was given to the director.

There were no Title 22 deficiencies cited during today's inspection.

Exit interview was conducted with Administrator Ann Vu and Director Cynthia Wojciechowski. 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: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy Port	TELEPHONE: (714) 703-2815
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2019

LIC809 (FAS) - (06/04)

Page: 3 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 CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 304370538
	VISIT DATE: 07/23/2019

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
26
27
28
29
30
31
32

Page 2 of 3

There is drinking water available to children both indoors and outdoors. A current menu is posted in a prominent location viewable by an authorized representative. Menus are dated, kept on file for 30 days and viewable upon request. The facility has a working smoke detector, carbon monoxide detector, and fire extinguisher that meet statutory requirements.

The playground was completely fenced. The playground equipment appeared in safe condition, and play area is free from hazards. There is sufficient sand cushioning underneath climbing structures and/or play equipment to absorb falls. The facility has conducted an emergency drill within the past six months.

A random sample of ten children's files were reviewed for documentation of the child’s name, address, and telephone number of the child’s authorized representative and of relatives or others that can assume responsibility for the child if the authorized representative cannot be reached when necessary (LIC 700) and a medical assessment. In the areas reviewed the children’s files were found to be in full compliance.

Sign in/out procedure was reviewed for compliance. This facility utilizes an electronic sign in/out system. Each person who signs the child in and out uses an individualized code/pin and the system records the time of the day. The child is signed in and out for the person responsible for the child.

Staff files for staff present during today’s inspection were reviewed for a health screening, immunization’s and mandated reporter training. At least one staff member present possesses current CPR/First Aid certifications, which expires 09/2019. Nine staff files were reviewed and contained a health screening as required. Proof of immunization's against influenza (or written decline), pertussis and measles for employees present during today’s inspection were reviewed and within compliance of SB 792. 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.

Page 2 of 3 (Continued on Page 3)

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy Port	TELEPHONE: (714) 703-2815
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2019

LIC809 (FAS) - (06/04)

Page: 2 of 3