334810747-3-7-2023-09-CC-GCAO-CPPPMX-20230307102704

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334810747
Report Date: 03/07/2023
Date Signed: 03/07/2023 10:27:10 AM

Document Has Been Signed on 03/07/2023 10:27 AM - 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	WOODCREST MONTESSORI EDUCATION CENTER		FACILITY NUMBER:	334810747
ADMINISTRATOR:	DIANE MARTINEZ		FACILITY TYPE:	850
ADDRESS:	16191 WASHINGTON STREET		TELEPHONE:	(951) 789-9319
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92504
CAPACITY:	66	CENSUS: 38	DATE:	03/07/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	07:31 AM
MET WITH:	Elzabeth Bunker		TIME COMPLETED:	10:30 AM

NARRATIVE

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On the date and time listed above, a case management visit is being conducted in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 02/22/23. It indicates a child had an allergic reaction while in care. LPA met with Licensee, Elizabeth Bunker to further discuss the incident.

During the course of this visit, LPA toured the facility, took census, reviewed records, and conducted interviews with pertinent parties involved.

Based on information gathered, the facility acted appropriately, and no violations have been identified. Immediate first aid was given; parent notification was made; staff/children ratios were maintained and a staff meeting was completed to review incident.

While no deficiencies are being cited, an Advisory Note is being issued for reporting requirements as facility self report was not made to the department within 24 hours or by next business day by phone or written report.

An exit interview was conducted, and LPA Carbullido provided the Licensee with a copy of this report, appeal rights and notice of site visit during today’s visit.

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle Carbullido	TELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023

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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