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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313611245
Report Date: 01/10/2020
Date Signed: 01/10/2020 02:50:56 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:ARBOR VIEW MONTESSORIFACILITY NUMBER:
313611245
ADMINISTRATOR:SAADEH, LYDIAFACILITY TYPE:
850
ADDRESS:7441 FOOTHILLS BLVD #140TELEPHONE:
(916) 787-4004
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY:46CENSUS: 17DATE:
01/10/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Lydia Saadeh - Director TIME COMPLETED:
02:45 PM
NARRATIVE
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An unannounced case management inspection was conducted today by Licensing Program Analyst Owens. LPA met with Director / Owner Lydia Saadeh. The purpose of the inspection is to address an unusual incident that occurred on December 11, 2019.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, the following deficiencies are found: see next page 809-D

Appeal rights provided to Director.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina OwensTELEPHONE: 916-263-6280
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)
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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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: ARBOR VIEW MONTESSORI
FACILITY NUMBER: 313611245
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/10/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/13/2020
Section Cited

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HEALTH-RELATED SERVICES:
The licensee shall immediately notify the child's authorized representative if the child becomes ill or sustains an injury more serious than a minor cut or scratch. The licensee shall obtain specific instructions from the authorized representative regarding action to be taken.
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This requirement is not met as evidence by the staff failed to contact authorized representative immediately following a serious incident. This is an immediate risk to a child.
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LIC 9224 was given and explained to Director at time of inspection.

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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: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina OwensTELEPHONE: 916-263-6280
LICENSING EVALUATOR SIGNATURE:
DATE: 01/10/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/10/2020
LIC809 (FAS) - (06/04)
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