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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371203
Report Date: 09/20/2019
Date Signed: 09/20/2019 12:53:45 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:LIMAI MONTESSORI ACADEMYFACILITY NUMBER:
304371203
ADMINISTRATOR:JANKI SHAHFACILITY TYPE:
850
ADDRESS:5309 BEACH BLVDTELEPHONE:
(714) 690-0112
CITY:BUENA PARKSTATE: CAZIP CODE:
90621
CAPACITY:139CENSUS: 56DATE:
09/20/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:06 AM
MET WITH:Janki Shah, DirectorTIME COMPLETED:
01:00 PM
NARRATIVE
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LPA Torrence conducted a case management inspection today to review a self-reported incident that was received in the licensing office on 09/12/2019. According to the self-reported incident: on 09/06/2019, two staff took 20 children outside to the playground. When the staff returned to the classroom with the children, census was not taken. After 2-3 minutes of returning to the classroom, the taken and it was discovered that only 17 children were brought back inside, staff realized three children was missing. A staff was walking in the hallway and saw two children next to the classroom door, and the third child was found on the playground. Per Director and Principal, the staff was terminated, on 09/11/19, after an investigation. Per Director, video surveillance of the incident is available. It was also discovered the incident was not reported to licensing within 24 hours.

Census was taken. LPA observed 26 children on the playground being supervised by four staff members, one classroom had 19 children, being supervised by two staff members, and the other classroom had eleven children being supervised by one staff member. A review of staff records on this date indicates that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During today's case management inspection, LPA Torrence discussed the incident with the director and principal, and was told the following: two staff counted the children before returning to the classroom and reported to the lead teacher that the count was 17, the lead teacher responded the count was 20, and never counted the children to verify. LPA Torrence reviewed the video surveillance footage. LPA observed three children outside, on the playground, underneath the playground structure, without any staff supervising them. LPA then observed two of the children running towards the classroom, leaving one child outside on the playground alone. LPA also observed a staff walking in the hallway and saw the two children standing by the classroom door, she took the children inside the classroom and then proceeded to go outside to check the playground for other children, that’s when she saw the other child on the playground crying.

Based on information disclosed in the self-reported incident and a review of the video footage, the following deficiencies are being cited in accordance with California Code of Regulations Title 22, Division 12, Section 101229(a)(1) Care and Supervision and Section 101212(d) Reporting Requirement. Deficiencies are cited on the attached LIC 809D. An immediate civil penalty of 500.00 was assessed today for Care and Supervision and 100.00 per day until corrected.


SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2019
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: LIMAI MONTESSORI ACADEMY
FACILITY NUMBER: 304371203
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/20/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/20/2019
Section Cited

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101229(a)(1) Responsibility for Providing Care and Supervision. The licensee shall provide care and supervision as necessary to meet the children's needs.
No child(ren) shall be left without the supervision of a teacher at any time….
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The requirement is not met as evidence by director disclosing that staff left two children in the hallway and the third child on the playground for 2-3 minutes. LPA observed the video and saw three children left on the playground. This poses an immediate risk to the health and safety of children in care. An immediate civil penalty of 500.00 was assessed today for Care and Supervision and 100.00 per day until corrected.

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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: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:
DATE: 09/20/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/20/2019
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: LIMAI MONTESSORI ACADEMY
FACILITY NUMBER: 304371203
VISIT DATE: 09/20/2019
NARRATIVE
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If the facility receives a Type A violation, 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.

Exit interview was conducted. The report was reviewed and discussed. The facility representative was provided a copy of their appeal rights (LIC 9058 12/15) and discussed. 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.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2019
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: LIMAI MONTESSORI ACADEMY
FACILITY NUMBER: 304371203
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/20/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/02/2019
Section Cited

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101212(d) Reporting Requirements. Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day…. a written report containing the information specified in (d)(2) …. submitted to the Department within seven days...
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The requirement is not met as evidence by director disclosing that the incident was not reported to licensing within 24 hours. This poses a potential risk to the 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: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:
DATE: 09/20/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/20/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4