340315188-4-20-2023-03-CC-JGAG-CR3TDH-20230420143823

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 340315188
Report Date: 04/20/2023
Date Signed: 04/20/2023 02:38:39 PM

Document Has Been Signed on 04/20/2023 02:38 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	VILLAGE MONTESSORI SCHOOL		FACILITY NUMBER:	340315188
ADMINISTRATOR:	WILLIS, LISA/AUERING, ERIN		FACILITY TYPE:	850
ADDRESS:	5033 FAIR OAKS BLVD		TELEPHONE:	(916) 488-6500
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	128	CENSUS: 94	DATE:	04/20/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Erin Auernig		TIME COMPLETED:	02:50 PM

NARRATIVE

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On Thursday April 20, 2023 at approximately 10:50 AM, Licensing Program Analyst (LPA) Josiah Gathing met with Director Erin Auernig for the purpose of an unannounced annual random inspection. LPA observed care and supervision of 94 preschool children and toddlers by 14 staff. The facility has a maximum capacity of 128. The facility hours of operation are Monday through Friday from 7:00 AM to 6:00 PM.

LPA toured the classrooms, circle room, children’s restrooms, staff restroom, kitchen, storage room, and outdoor play areas. Director stated there are no poisons or firearms on the premises. Toxic and hazardous items are inaccessible to children. Furniture and equipment are in good condition. Playground equipment and surfaces are free of loose or sharp parts and the ground below the play structure is sufficiently padded. Restrooms are in sanitary condition with functioning toilets. The floors were clean throughout the facility. Medications are stored out of children’s reach and according to regulation.

LPA observed that solid waste containers were covered. Per Director, the facility provides snacks and parents provide meals daily. Drinking water was readily available to children both indoors and outdoors. LPA observed sign in and out sheets which showed all children present with parent’s full signatures.

During staff file review, LPA observed that one staff member present did not obtain fingerprinting for criminal record clearance prior to employment in the facility. This staff member was employed by the facility in 2022 and the presence of this staff member is in violation of licensing requirements until criminal record clearance is obtained. LPA observed all other staff records to be complete. LPA observed current Mandated Reporter certificate which will expire July 28, 2023 and current CPR and First Aid certificate which will expire August 11, 2023.

Report continues on LIC809-C…

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Josiah Gathing	TELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

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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Document Has Been Signed on 04/20/2023 02:38 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: VILLAGE MONTESSORI SCHOOL	FACILITY NUMBER: 340315188
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/20/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

101170(e)(1)

Criminal Record Clearance

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above one staff member present during today's inspection did not have a criminal record clearance on file which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 04/21/2023
	Plan of Correction
1 2 3 4	Director will have the staff member fingerprinted before returning to work in the facility. Parents will be notified of the citation.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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 Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Josiah Gathing	TELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

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: VILLAGE MONTESSORI SCHOOL	FACILITY NUMBER: 340315188
	VISIT DATE: 04/20/2023

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LPA observed the sample of children’s files contained the appropriate documents. LPA observed complete children’s roster on file. LPA observed first aid equipment, functioning smoke and carbon monoxide detectors, and a fully charged fire extinguisher meeting regulation. Required documents were posted.

LPA discussed Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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.htm

Facility Director was encouraged to the visit the Department's website at WWW.CCLD.CA.GOV for information regarding child care updates, PINs, forms, regulations and legislation pertaining to child care centers.

Exit interview was conducted and report was reviewed with the Director. A notice of site visit was given and must remain posted for 30 days.

A deficiency is cited on the following LIC809-D and a civil penalty is assessed. Appeal Rights were provided.

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Josiah Gathing	TELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

LIC809 (FAS) - (06/04)

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