304371475-7-29-2021-06-CC-KDEI-C5DTYL-20210729150857

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371475
Report Date: 07/29/2021
Date Signed: 07/29/2021 03:09:14 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:	BUENA PARK MONTESSORI ACADEMY		FACILITY NUMBER:	304371475
ADMINISTRATOR:	GUNASEKARA, HISSANKA S.		FACILITY TYPE:	830
ADDRESS:	6221 LINCOLN AVENUE		TELEPHONE:	(714) 821-7800
CITY:	BUENA PARK	STATE: CA	ZIP CODE:	90620
CAPACITY:	32	CENSUS: 0	DATE:	07/29/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Administrator Mr. Gunasekara, Hissanka & Mrs. Gunasekara Harshini		TIME COMPLETED:	03:30 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) Ms. Ketki Desai conducted an announced on site pre-licensing inspection at the childcare center. It is a Change of Ownership. LPA met with Facility Administrator Mr. Gunasekara, Hissanka & Mrs. Gunasekara Harshini who gave a tour of the Child Care Center. Applicant is requesting Infant with Toddler option, providing care and supervision to 12 Infants (6 weeks - 2 years) and 15 Toddlers (18 months to 36 months), Monday through Friday 6.30 am. to 6.30 PM. in the assigned two classrooms. Due to COVID 19, LPA observed staff wearing face mask, social distancing and following CDC and Dept of Public Health Guidelines. A review of the Facility Personnel Report Summary on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. The facility has a huge parking lot, for parent drop off and pick up, there is entrance gate with a key pad and the code shall be provided to enrolled parents, upon entering these area, facility staff shall check their temperature, sanitize their hands and soles of the shoes before they are taken to the classroom. Due to COVID Pandemic parents are encouraged to follow the CDC and COVID requirements, Infants and Toddlers shall be received at the entrance door by the staff, temperatures are checked, hands are sanitized before they are taken to their classrooms and the parents sign them manually, sign in binders are placed on the table where the staff receive the infants and other children. Parents with infants shall have access through the main entrance of the facility, There is separate door leading to Infant/ Toddler room through the walkway passage on the left side of the gate which is completely fenced, each door is only operated from inside only. The office area is located in front of the main entrance door of the facility, adjoining to it is the staff room with bathroom and the Kitchen area. (Page-1)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021

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: BUENA PARK MONTESSORI ACADEMY	FACILITY NUMBER: 304371475
	VISIT DATE: 07/29/2021

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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 were inspected in the indoor activity space: (Infant / Toddler room)
· Classrooms are adequately equipped with age and size appropriate furniture and equipment
· Sign in/Sign out procedure was reviewed and meets regulation requirements (Manually)
· There is a working smoke detector, carbon monoxide detector and fire extinguisher that meet statutory requirements
· Cubbies available for storage of individual child’s personal belongings and/or bedding
· Napping equipment shall be stored in individual cubbies when not in use and Cribs for younger infants and Cots for older infants and toddlers shall be used.
· The changing table is within arm’s reach of a sink/ the changing table is padded with raised sides in each of the Infant and Toddler room
· All bedding linens shall be provided by the parents
· There is a designated napping area surrounded by a 4 ft wall with sufficient infant napping equipment's
· The infant indoor is physically separate from the preschool component
There is one Toilet in the toddler classroom along with one sink within arm's length of the changing station

Center policy is that formula/ baby food/ Diapers/ pull ups/ lotions / wipes/ crib linens/ personal utensils/ bowls are to be provided by the parents, every infant shall have their own bin to store personal items.
LPA discussed the posting requirements including, but limited to, the following:
· Facility License in public area (101160)
· Emergency Disaster Plan (LIC 610) / Earthquake Preparedness Check List (LIC 9148)
· Parents’ Rights Poster (PUB 393) / Personal Rights (LIC 613A)
· Menus / Activity Schedule
(Page-2)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021

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: BUENA PARK MONTESSORI ACADEMY	FACILITY NUMBER: 304371475
	VISIT DATE: 07/29/2021

NARRATIVE

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· Notice of Site Visit (LIC 9213) and Type A deficiencies / Plan of Corrections of Type A deficiencies
· Granted Waivers (available for review)
· Child Car Seat Law (PUB 269)
· Sudden Infant Death Syndrome Poster
· Shaken Baby Syndrome Poste r

Indoor activity space : Infant room
Infant room: 37'83 X 12'42= 469'85 - 33'90 (Kitchen counter/ changing station/ sink /Refrigerator) = 435'95
Total Infant area : 435'95 divided by 35 = 12'45 ( 12 Infants)
There is one sink within the arm's reach of the changing station and a second sink on the kitchen counter
Total 2 sinks in the classroom.

Toddler room measurements
Toddler room (Small area next to napping area) : 18'42 x 9.83 = 181'06 - 14'48 = 166'58
Toddler room (Big open area) : 19'75 x 18'92 = 373'67

Total Indoor measurements for Toddler room : 540'25 divided by 35= 15'44 ( 15 toddlers)
There are three sinks/ One changing station and One toilet inside the toddler classroom

Facility has separate Infant yard and Toddler yard. The yard shall be assessed from the individual room in the classroom, walking through the fenced passage area outside the classrooms to gain access, there are two small gates at the entrance of the yard. Infants shall walk through the Toddler yard to gain access to the Infant yard. Facility has designated time for each component, hence during transition there are no toddlers present in their yard while Infants walk through it.

The following were inspected in the outdoor activity space;
· Playground is fully enclosed by an appropriate fencing
· Outdoor activity space is supplied with age and size appropriate equipment's
· An adequate amount of cushioning material consisting of artificial grass
· Adequate shade is provided by tree

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021

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: BUENA PARK MONTESSORI ACADEMY	FACILITY NUMBER: 304371475
	VISIT DATE: 07/29/2021

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Outdoor Infant and Toddler yard Measurements
Infant Yard : 35'42 X 26= 920'92 divided by 75 = 12'27

Toddler Yard: 50 X 35.42 = 1771 divided by 75 =23'61

Facility has sufficient outdoor space in each yard for the capacity requested.

LPA discussed with the applicant/facility representative that all employees must have criminal record clearances associated to the facility prior to their presence in the facility, staff to child ratio requirements, direct visual supervision requirements, emergency/disaster drills, children records, mandated reporter training, and staff immunization requirements against measles, pertussis, and influenza. Applicant/facility representative was advised the infant crib area must be supervised at all times. No infant should be left unattended in the crib area. bedding must be stored individually and may not touch another children's bedding

Applicant was informed of Mandated Reporter Training for self and all assistants. Department web site form was given to down load forms, Title 22 regulations, and training's on-line at www.ccld.ca.gov. The applicant/facility representative was also informed to visit the website for Quarterly Updates. The applicant was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov. or at www.ccld.ca.gov

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 applicant/facility representative 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

A copy of the 2016 “A Child Care Providers Guild to Safe Sleep” was provided to the applicant/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: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021

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: BUENA PARK MONTESSORI ACADEMY	FACILITY NUMBER: 304371475
	VISIT DATE: 07/29/2021

NARRATIVE

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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.

The facility was in compliance with Title 22 requirements at the time of the inspection.

The applicant was given a pamphlet on Lead Exposure and was discussed with provider. Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org. The Chaptered Legislation for AB 2084 (Nutritious Beverages) is available to view on the website at: http://ccld.ca.gov/res/pdf/12APX-11.pdf

LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

A copy of PIN 20-24 was also provided to the applicant.

Based on today’s measurements, and the sink and toilet availability, this center does have sufficient Indoor and outdoor activity space to support the capacity of 12 infants and 15 Toddlers as requested

A license will be issued for the capacity of 12 Infants ( 6 weeks - 24 months) in Infant room and 15 Toddlers (18 -36 months in the Toddler room) after a final review. Applicant shall be notified if additional information is needed. (Total Capacity: 27)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021

LIC809 (FAS) - (06/04)

Page: 6 of 6

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: BUENA PARK MONTESSORI ACADEMY	FACILITY NUMBER: 304371475
	VISIT DATE: 07/29/2021

NARRATIVE

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Fire Clearance has been received from Orange County Fire Authorities approving a total capacity of 105 children ( 78 Preschool children/ 12 Infants and 15 Toddlers ) in the assigned three Preschool rooms. one Infant room and one toddler room on 7/13/2021.

Administrator has met the requirements for the required Pediatric and CPR training valid through 04/2023 , along with the Preventative Health and Safety training for Nutrition and Lead component.
Water analysis for Lead component has been completed and is on file for review.

Applicant was also advised, once licensed, the Notice of Site Visit must be posted for 30 days and if A violations are cited then the Licensing Report (LIC809 or 9099) must be posted by the Notice of Site Visit for a period of 30 days or $100 civil penalties will be assessed, and the report shall posted and copies provided to the 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

An exit interview was completed. The report was reviewed and discussed. Appeal Rights were discussed. The applicant was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Licensing office within 15 business days

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021

LIC809 (FAS) - (06/04)

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