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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334846096
Report Date: 04/21/2022
Date Signed: 04/21/2022 12:36:26 PM


Document Has Been Signed on 04/21/2022 12:36 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501



FACILITY NAME:GREEN RIVER MONTESSORIFACILITY NUMBER:
334846096
ADMINISTRATOR:SACHDEV, SAPNAFACILITY TYPE:
840
ADDRESS:2791 GREEN RIVER, SUITE 112TELEPHONE:
(951) 735-5490
CITY:CORONASTATE: CAZIP CODE:
92882
CAPACITY:11CENSUS: 0DATE:
04/21/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Director Sapna SachdevTIME COMPLETED:
12:50 PM
NARRATIVE
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On 4/21/2022, Licensing Program Analyst (LPA) Samuel Lopez arrived at the facility to address another issue and learned that an incident occurred on 4/12/2022, which the local law enforcement arrived to the facility, and followed up on two days later, on 4/14/2022. The issue that law enforcement was addressing, was that of a parent violating a court order against them. This incident should have been reported to the Riverside Child Care Regional office within 24 hours of its occurrence or knowledge but, was not until LPA Lopez arrived on 4/21/2022.

The facility did not comply with the regulation regarding Reporting Requirements.

See LIC 809-D for cited deficiency

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.



An exit interview was conducted, and the report was reviewed with the Director Sapna Sachdev.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Samuel LopezTELEPHONE: (951) 897-2482
LICENSING EVALUATOR SIGNATURE:
DATE: 04/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/21/2022
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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Document Has Been Signed on 04/21/2022 12:36 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501


FACILITY NAME: GREEN RIVER MONTESSORI
FACILITY NUMBER: 334846096

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/28/2022
Section Cited

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Reporting Requirements: Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition,
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a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. This requirement was not being met as evidenced by a reportable incident occuring and not reported to CCL. ------>
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This poses a potential risk to the health and safety of the children in care.

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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: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Samuel LopezTELEPHONE: (951) 897-2482
LICENSING EVALUATOR SIGNATURE:
DATE: 04/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/21/2022
LIC809 (FAS) - (06/04)
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