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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343613062
Report Date: 09/22/2021
Date Signed: 09/22/2021 12:29:28 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:LITTLE BLOSSOM MONTESSORI SCHOOL, INC.FACILITY NUMBER:
343613062
ADMINISTRATOR:PHILLIPS, FELICIAFACILITY TYPE:
830
ADDRESS:2075 ARENA BLVD.TELEPHONE:
(916) 515-0550
CITY:SACRAMENTOSTATE: CAZIP CODE:
95834
CAPACITY:40CENSUS: 11DATE:
09/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Subashini Ranatanga and Lakshman RanatungaTIME COMPLETED:
12:35 PM
NARRATIVE
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On Wednesday, 09/22/2021 at 8:15am, Licensing Program Analyst (LPA) Jan Hoshida conducted an unannounced annual random inspection for the infant program. LPA met with Director Subashini (Sue) Ranatang and Administrator Lakshman (Lucky) Rantunga. Upon arrival, LPA observed 11 infants supervised by four staff members.

LPA conducted a health and safety inspection inside and outside of the facility. The infant indoor and outdoor activity space is physically separate from the space used by other day care children. Infant furniture and equipment, including cribs, cots/mats, and feeding chairs are sufficient, age appropriate and in good repair. Infant changing table has a padded surface no less than one inch thick, covered with washable vinyl or plastic, and has raised sides at least three inches high. Toys are safe, without sharp points, edges, splinters or small parts that can be pulled off and swallowed. Facility is in compliance with staff infant ratios. All infants including those napping in cribs are under visual observation at all times.

Feeding plans, Needs and Services plans, and Individual Infant Sleeping Plans (LIC 9227) for some infants. Sign in/out is completed on a digital keypad. Staff utilized as infant teachers have three child development units in infant/toddler care. Firearms and ammunition are not on the premises. Director acknowledged that storage area for poisons needs to be locked and stated that there are no poisons on site. Disinfectants, hazardous items and medications are inaccessible to children. Rooms are safe and clean. The facility is in compliance with conditions and limitations specified on the license. All staff subject to a criminal record clearance or exemption are associated to the facility. Emergency information reviewed for some children. Staff records reviewed contain documentation of the educational background, training, and/or experience and, a Health Screening/TB test and immunization records to meet SB 792. Operating hours are Monday thru Friday from 7:00am to 5:30pm.

REPORT CONTINUED ON NEXT PAGE
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Jan HoshidaTELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021
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: LITTLE BLOSSOM MONTESSORI SCHOOL, INC.
FACILITY NUMBER: 343613062
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/22/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101174(d)
Disaster and Mass Casualty Plan
(d) Disaster drills shall be conducted at least every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/22/2021
Plan of Correction
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Administrator stated that they will conduct a fire drill and submit proof to LPA by POC due date of 10/22/21.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in four out of four staff files which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/22/2021
Plan of Correction
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Administrator stated that they will have all staff complete the online Mandated Reporter training and submit proof to LPA by POC due date of 10/22/21.
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: Jan HoshidaTELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:
DATE: 09/22/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/22/2021
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: LITTLE BLOSSOM MONTESSORI SCHOOL, INC.
FACILITY NUMBER: 343613062
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/22/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(f)
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 is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/22/2021
Plan of Correction
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Administrator stated that they will have staff complete the EMSA-certified pediatric CPR/1st aid training and submit proof to LPA by POC due date of 10/22/21.
Type B
Section Cited
CCR
101427(j)
Infant Care Food Service
(j) Bottles, dishes and containers of food brought by the infant's authorized representative shall be labeled with the infant's name and the current date.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/22/2021
Plan of Correction
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Administrator stated that they will train staff to ensure that all bottles, dishes and containers of food brought from home are labeled with the infant's name and the current date. Owner stated that they will submit proof of staff training to LPA by POC due date of 10/22/21.
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: Jan HoshidaTELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:
DATE: 09/22/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/22/2021
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: LITTLE BLOSSOM MONTESSORI SCHOOL, INC.
FACILITY NUMBER: 343613062
VISIT DATE: 09/22/2021
NARRATIVE
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LPA did not observe a current fire drill log. Director stated that they do not have any staff that have a current EMSA-certified CPR/1st Aid training. LPA did not observe updated Mandated Reporter training for staff and last training was completed on 3/13/18. LPA observed that the bottles and children’s food was labeled with their name, but they did not have the date on the bottles and food items.

LPA observed that the padding of the ground in the outdoor play area has gaps between the squares that could cause a tripping hazard for the children in care. Director and Administrator stated that they have received estimates to completely change out the foam ground covering. Director and Administrator stated that they understand that the ground in the outdoor play area must be addressed and will fill in the gaps of between the foam squares. Staff stated that they did not bring the sippy cups of the children during outside play in the morning because the cups were left in the classroom during drop off. LPA observed that the sippy cups were on the counter in the classroom. Staff stated that they will bring the water cups outside and ensure that children have access to water inside and outside at all times.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. 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. Director stated that they currently do not have any children with medication that attend the facility.

LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

REPORT CONTINUED ON NEXT PAGE

SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Jan HoshidaTELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021
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: LITTLE BLOSSOM MONTESSORI SCHOOL, INC.
FACILITY NUMBER: 343613062
VISIT DATE: 09/22/2021
NARRATIVE
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Facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

In the areas that were evaluated, deficiencies were observed at the time of the visit and cited on LIC 809-D. Exit interview conducted and report was reviewed with the facility representative Lakshman (Lucky) Rantunga. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Jan HoshidaTELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021
LIC809 (FAS) - (06/04)
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