330910342-3-14-2024-09-CC-SBRR-D3CTWD-20240314150521

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 330910342
Report Date: 03/14/2024
Date Signed: 03/14/2024 03:05:27 PM

Document Has Been Signed on 03/14/2024 03:05 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	COTTONWOOD MONTESSORI		FACILITY NUMBER:	330910342
ADMINISTRATOR:	ANOMA PERERA		FACILITY TYPE:	850
ADDRESS:	4302 PEDLEY RD.		TELEPHONE:	(951) 685-5800
CITY:	RIVERSIDE,	STATE: CA	ZIP CODE:	92509
CAPACITY:	60	CENSUS: 31	DATE:	03/14/2024
TYPE OF VISIT:	Case Management - Lead Testing/Exceedance	UNANNOUNCED	TIME BEGAN:	08:18 AM
MET WITH:	Anoma Perera		TIME COMPLETED:	03:15 PM

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Due to required lead testing requirements, Licensing Program Analyst (LPA), Susan Brewer conducted a Case Management inspection based on lead testing results received on the facility. LPA S. Brewer toured the facility, took census and met with Licensee Director Anoma Perera, to further discuss lead results received and measures taken for remediation of lead exceedances.

During the inspection, LPA toured and obtained photos of the following water outlets identified with lead exceedances: Fountain Outlet C, 5.6 ppb, Faucet Outlet D 8.3 which is located in Classroom #2 and the Fountain Outlet H, 31.0 ppb which is located passageway, next to Classroom 1 entrance. LPA observed and obtained photos of required signage posted at outlets for cessation of use.

Facility implemented the following plan of action until formal remediation can be completed on water outlets: Covered water outlets and posted required signage for nonuse. The facility and agreed to develop and submit a plan to repair Outlets C, D and H, identified to have Action Level Exceedances and will schedule with a certified vendor for retesting, following the repair. LPA observed notification of lead results posted at the facility’s front desk reception and sign-in/sign-out location.

Photos also obtained of additional source for access to water: Facility has access to additional water resources: fountains using water with approved lead levels, water bottles and filtered water dispenser for indoor/outdoor activities.

Due to facility water outlets testing above approved lead levels, a deficiency has been cited. See LIC809D.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Susan Brewer	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024

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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: COTTONWOOD MONTESSORI	FACILITY NUMBER: 330910342
	VISIT DATE: 03/14/2024

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Additionally, the following resources were discussed and provided from PIN 21-21.1 -CCP dated December 28, 2022:

101700.6 Grant Funding for Qualifying Child care Centers

(a) Senate Bill 862, Chapter 449, Statutes of 2018 allocated $5 Million to the State Water Resources Control Board for testing and remediation of lead in the drinking water of Child Care Centers based on the following criteria:

(1) Those that serve children zero to five years of age, with the highest priority for Child Care Centers that provide care for children zero to three years of age.

(2) Those that have 50 percent or more of their registered children who receive subsidized care.

(3) Those that operate only one facility.

(b) To determine a Child Care Center’s eligibility for possible funding the Department will provide access to a link to an online eligibility form located on the Department’s website and on Sacramento State’s Office of Water Programs website.

(1) A Child Care Center interested in financial assistance shall complete the eligibility form, which shall include instructions for completing and returning it, prior to receiving any grant funding for which it may qualify. To determine a Child Care Center’s eligibility for possible funding, the provider will need to complete an online eligibility form available at Office of Water Programs’ website

An exit interview was conducted and a copy of this report was left with the director Anoma Perera. This report must be made available to the public upon request for three years.

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Susan Brewer	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/14/2024 03:05 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: COTTONWOOD MONTESSORI	FACILITY NUMBER: 330910342
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/14/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/15/2024 Section Cited CCR 101700.3(b)(1)	1 2 3 4 5 6 7	101700.3 (b)(1): A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement is not met as evidence by:	1 2 3 4 5 6 7	Facility will implement corrective action pursuant to section CCR 101704 for immediate cessation of outlets C, D and H, testing with action level exceedance until it is replaced and retested pursuant to section CCR 101705 and returns a result at or below the Acton level.
	8 9 10 11 12 13 14	Based on records review of required lead testing conducted on 12/15/2022, the facility had lead values of 5.5 or above reported on 01/05/2023 for water outlets C-5.6 ppb, D-8.3 ppb and H 31.0 ppb. This is a potential health and safety risk to persons in care.	8 9 10 11 12 13 14	Facility will notify CDSS with completion within 30 days.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Kimberly Williams	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Susan Brewer	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024

LIC809 (FAS) - (06/04)

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