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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340315188
Report Date: 07/19/2021
Date Signed: 07/19/2021 12:54:52 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:VILLAGE MONTESSORI SCHOOLFACILITY NUMBER:
340315188
ADMINISTRATOR:WILLIS, LISA/AUERING, ERINFACILITY TYPE:
850
ADDRESS:5033 FAIR OAKS BLVDTELEPHONE:
(916) 488-6500
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:128CENSUS: 62DATE:
07/19/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Erin AuernigTIME COMPLETED:
01:10 PM
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At 9:00 a.m. on Monday, July 19th, 2021, Licensing Program Analyst (LPA) Karyn Guerra met with Director, Erin Auernig, for the purpose of an unannounced annual random inspection. A risk assessment for COVID-19 was conducted via telephone prior to inspection. Temporary operating hours of the facility are 7:30 a.m.-5:30 p.m. At 9:10 a.m., LPA conducted a census of the facility and observed 17 preschool children supervised by 2 staff in classroom one, 14 preschool children supervised by 2 staff in classroom two, 11 preschool children supervised by 2 staff in classroom three, 9 toddler children supervised by 2 staff in classroom four, and 11 preschool children supervised by 1 staff in classroom five, who were outside on the play yard. LPA observed all but one staff wearing masks indoors. LPA provided and reviewed updated COVID-19 guidance for child care.

At 9:20 a.m., LPA conducted a health and safety inspection of the outdoor space. Facility sign in and sign out binders are located outside of classroom doors. LPA discussed reminding parents to sign in and out using their full legal signature instead of initials. LPA observed functioning water fountains. Playground equipment and surfaces are free of loose or sharp parts. LPA observed wood chip cushioning beneath the play structure. LPA discussed raking the tanbark in high traffic areas such as under the slide and swings to provide better cushioning. Outdoor shade was provided by trees and canopies. Facility has an outdoor pool. Pool is fenced with a self-latching gate that swings away from the pool. Fencing is 6 feet tall. At 9:40 a.m., LPA observed self-latching device located 15 inches from top of gate. This poses a potential risk to children in care.

Report continued on 809-C.

SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 5
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: VILLAGE MONTESSORI SCHOOL
FACILITY NUMBER: 340315188
VISIT DATE: 07/19/2021
NARRATIVE
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At 9:50, LPA conducted a health and safety inspection of the classrooms, restrooms, and food service areas. LPA observed the following documents are posted: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, car seat laws, menus, and daily schedule. Cleaning disinfectants and hazardous items are appropriately stored and inaccessible to children in out of reach cabinets. Director stated there are no poisons nor firearms on the premises. At 9:51 a.m. LPA observed exposed foam and torn vinyl covering on napping mats. This poses a potential risk to children in care. Toileting facilities are in safe, sanitary, and operating condition. Bins for solid waste have tight fitting lids. The floors appeared clean throughout the facility. Facility provides morning and afternoon snacks. Food was properly stored to prevent contamination. Children have individual bottles for drinking water. Director will ensure that all bottles are labeled.

At 10:25 a.m., LPA reviewed children's records. Each child's file contained an admission agreement, emergency card, health history, physician report, personal rights, consent for emergency medical treatment, parent’s rights receipt, and immunization record. At 10:40 a.m., LPA reviewed staff files. At 10:40 a.m., LPA observed CPR and First aid certification for staff that expired on 4/19/2021. This poses a potential risk for children in care. LPA observed staff immunization records. At 10:41 a.m., LPA observed AB 1207 Mandated Reporter training certificates that expired in March 2020. This poses a potential risk to children in care. LPA observed health screenings, employee rights, and documentation of the educational background, training, and/or experience.

Annual fees are not current. LPA reviewed outstanding fees with Director.

This facility is not currently providing Incidental Medical Services – IMS. LPA reviewed need for an IMS plan of operation to be on file at the facility, should IMS services be provided. LPA reviewed storage of medication and equipment/supplies. Medications are normally stored in the kitchen cabinet, inaccessible to children. No medications were present. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.



Report continues on 809-C.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: VILLAGE MONTESSORI SCHOOL
FACILITY NUMBER: 340315188
VISIT DATE: 07/19/2021
NARRATIVE
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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.html.

This facility evaluation report was reviewed and discussed with the Director. A Notice of Site Visit was provided and shall remain posted for a period of 30 days for parental review. Director was encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining child care centers. Title 22 regulatory violations are cited on the subsequent pages of this report. Appeal rights were provided. Director's signature on this report acknowledges receipt of these rights. An exit interview was conducted.

SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: VILLAGE MONTESSORI SCHOOL
FACILITY NUMBER: 340315188
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/19/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/19/2021
Section Cited

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101239.1 Napping Equipment
(b) Floor mats used for napping shall be: (5) Maintained in a safe condition with no exposed foam.
This requirement was not met, as evidenced by:
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Based on observation, there was exposed foam and tearing of vinyl on multiple mats in the facility. This poses a potential risk to children in care.
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Type B
08/19/2021
Section Cited

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101238 Buildings and Grounds (e) All licensees shall ensure the inaccessibility of pools...or similar bodies of water, through a pool cover or by surrounding the pool with a fence. (1) ...gates shall...have a self-latching device located no more than six inches from the top of the gate. This requirement was not met, as evidenced by:
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Based on observation, self-latching device was located more than six inches from the top of the gate. This poses a potential risk to 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: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:
DATE: 07/19/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/19/2021
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: VILLAGE MONTESSORI SCHOOL
FACILITY NUMBER: 340315188
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/19/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/19/2021
Section Cited

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101216 Personnel Requirements (f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities. This requirement was not met, as evidenced by:
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Based on observation, LPA did not see proof of current CPR and Pediatric First Aid training for any staff at the facility. This poses a potential risk to children in care.
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Type B
08/19/2021
Section Cited

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1596.8662(4)(b)(1) Mandated Reporter Training. On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care providor....or employee of a licensed child day care facility shall complete the mandated reporter training provided...and shall complete renewal of mandated reporter training every two years following...This requirement was not met, as evidenced by:
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Based on observation during staff file reviews, renewal of mandated reporter training was not completed. This poses a potential risk to 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: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:
DATE: 07/19/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/19/2021
LIC809 (FAS) - (06/04)
Page: 5 of 5