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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371166
Report Date: 01/10/2020
Date Signed: 01/10/2020 02:56:56 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 SCHOOL OF SAN CLEMENTE, LLCFACILITY NUMBER:
304371166
ADMINISTRATOR:ROUSH, JAIMEE LYNNFACILITY TYPE:
830
ADDRESS:1141 PUERTA DEL SOLTELEPHONE:
(949) 276-4160
CITY:SAN CLEMENTESTATE: CAZIP CODE:
92673
CAPACITY:40CENSUS: 26DATE:
01/10/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Administrator Roush Jaimee Lynn TIME COMPLETED:
03:15 PM
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An unannounced annual random Inspection was conducted on this day by Licensing Program Analyst (LPA) Ketki Desai in accordance with Community Care Licensing (CCL) Title 22 Division 12 Chapter 1, governing Infant Child Care Centers. Facility is currently licensed for a capacity of 40 infants. Licensing staff met with Administrator Jamiee Lynn. The program currently operates Monday thru Friday from 6.30 AM to 6.00 PM. Licensing staff was taken on a guided tour of the facility of both indoors and outdoors.

During the site inspection, there is a total census of 26 infants including Toddlers present and a total census of 7 teachers present.
Census: Infant Room # 1: 8 infants with 4 teachers : Infant crib area is separate and staff is seated inside while the infant is in the crib. (2) Waddlers room: 12-18 months infants: 10 infants & toddlers with 2 staff Room # 3& 4 were combined with 8 napping toddlers with one staff.

Furniture and equipment was inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Storage for infants’ belongings and napping equipment/cribs was inspected and meet all regulatory requirements. Availability of drinking water was reviewed. The children have their own sippy-cups with their names written on them. Age appropriate sinks and potty chairs were inspected for availability, good repair, water temperature, area safety and sanitation. Changing table has raised sides at least three inches high and is within an arm’s reach of a hand washing sink. Toys observed to be clean.

A first aid kit is kept in each classroom. Carbon monoxide detectors and smoke detectors are present in the facility. Storage cabinet in classrooms was locked and hazardous items including poisonous cleaning compounds were stored inaccessible to children. Director's office is used as an Isolation area for sick children with a designated mat.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2020
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 SCHOOL OF SAN CLEMENTE, LLC
FACILITY NUMBER: 304371166
VISIT DATE: 01/10/2020
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Infants and Toddlers bring their own bedding materials which are sent home at the end of each day to be laundered. Storage for children's belongings was reviewed. Food preparation areas were toured for safety, cleanliness and proper equipment. Meals are provided by parents. Bottles, dishes, and containers were labeled with infants’ names; dates were visible on all children's bottles and other refrigerated items.

Teacher-infant ratios were observed and staff names recorded. Care and supervision was evaluated to determine if the basic needs of infants are met and appropriate. Infant Needs and Assessments are done quarterly. Sign-in and out sheets and procedures were reviewed. Personal Rights of infants were observed by LPA. Staff and Infant Records were reviewed for completeness. Inspection of required forms made.

Staff and Children’s Records were reviewed. Criminal Record Clearances were reviewed for adults. CPR card expires in October 2020 for Opening teacher . Inspection of required forms made.

Incidental Medical Services (IMS) policy was discussed. 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

The following was discussed with the Director:
Rooms that are off-limits need to be made inaccessible during operating hours. Smoking is prohibited. No infant walkers, no Johnny Jumpers, no excer-saucers or any other item that falls into that category are allowed in facility.

The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and Carbon Monoxide detectors should be checked and batteries replaced as needed. Last disaster drill was conducted on 11/15/2019. Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your location.

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

DATE: 01/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2020
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 SCHOOL OF SAN CLEMENTE, LLC
FACILITY NUMBER: 304371166
VISIT DATE: 01/10/2020
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Information on the additional nutrition training, immunization requirements for children, and Health Schools Act (http://www.cdpr.ca.gov/docs/pestmgt/schoolipm.htm) were provided. The Administrator was informed, and website given, about the California Child Care Disaster Plan has been posted to the UCSF California Childcare Health Program website: cchp.ucsf.edu/content/disaster-preparedness Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org A copy of the California Department of Social Services Lead Information Brochure was explained and provided to the facility representative.

A copy of the 2016 “A Child Care Providers Guild to Safe Sleep” was provided to the Facility Administrator
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
https//www.cdph.ca.gov/programs/SIDS/Documents/ChildCareProvSleepSPAN2011.pdf
AAP: //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
· Always place infants on their backs for sleeping
· Use only a tight-fitting sheet on the crib or play yard mattress
· Do not hang any items from the crib or above the crib
· Keep all items, including blankets, out of the crib or play yard
· Pacifiers may be used as long as they do not have items attached to them
· Infants should not be swaddled or have any items covering them while sleeping
· The temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold.

In the areas that were evaluated, no deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit. An exit interview was completed with Facility Administrator The report was reviewed and discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights.

The facility representative was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. The “Notice of Site Visit” must be posted on or adjacent to the door. Failure to post will result in Civil Penalties of $100.0
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3