304371208-2-25-2022-06-CC-PRIS-CBYUEQ-20220225143131

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371208
Report Date: 02/25/2022
Date Signed: 02/25/2022 02:31:36 PM

Document Has Been Signed on 02/25/2022 02:31 PM - It Cannot Be Edited

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 ACADEMY AT THE RANCH		FACILITY NUMBER:	304371208
ADMINISTRATOR:	KIM, TAMARA LEW		FACILITY TYPE:	850
ADDRESS:	74 ESENCIA DR		TELEPHONE:	(949) 234-6136
CITY:	RANCHO MISSION VIEJO	STATE: CA	ZIP CODE:	92694
CAPACITY:	180	CENSUS: 114	DATE:	02/25/2022
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Tamara Lew Kim, Director		TIME COMPLETED:	01:00 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	Licensing Program Analyst (LPA) Patricia Rivas conducted an unannounced case management visit to investigate Two incident reports provided by facility. A review of the Facility Personnel Report Summary on 02/25/2022 indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions During today' visit. LPA toured classrooms, interviewed staff . LPA observed 114 children and 16 teachers. One incident report alleged staff (S1) hurt Child1's (C1) wrist. Per Director, Date of alleged incident and time were not provided. Director reports she was advised of the allegation on 02/22/22. Regional Office (RO) received Unusual incident report on 02/23/22. LPA interviewed 5 staff all 5 denied seeing S1 violate any child's personal rights. LPA interviewed C1 who was qualified and stated "nope" when asked if S1 hurt child. S1 denies hurting any child, or violating any personal rights. LPA was unable to corroborate allegation. Preponderance of evidence showing a violation occurred was not found. The second incident was verbally reported on 02/23/22. It was alleged that S2 hit C2. Date of alleged incident was not provided. LPA interviewed 5 staff who all denied seeing S2 hit C2. Director reports S2 is no longer working at the facility and C2 was not present today. Due to insufficient information at this time LPA will continue the investigation. LPA observed a few children entering the facility without wearing or putting on a mask, even though masks were readily available upon sign in. LPA also observed some children not wearing masks inside the classroom. Masks were provided to children during visit. LPA provided copy of PIN 21-29 CCP for reference.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat Rivas	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022

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 ACADEMY AT THE RANCH	FACILITY NUMBER: 304371208
	VISIT DATE: 02/25/2022

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No Deficiencies cited during today's visit.

Exit interview was Director, Kim was provided a copy of appeal rights (LIC 9058) 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the Regional Manager to the address listed.

The Notice of Site Visit was given and discussed it must be posted as required by H & S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat Rivas	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022

LIC809 (FAS) - (06/04)

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