343613062-6-20-2023-03-CC-MGON-CSYTQN-20230620145613

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343613062
Report Date: 06/20/2023
Date Signed: 06/20/2023 02:56:32 PM

Document Has Been Signed on 06/20/2023 02:56 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	LITTLE BLOSSOM MONTESSORI SCHOOL, INC.		FACILITY NUMBER:	343613062
ADMINISTRATOR:	RANATUNGA, SUBASHINI (SUE)		FACILITY TYPE:	830
ADDRESS:	2075 ARENA BLVD.		TELEPHONE:	(916) 515-0550
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95834
CAPACITY:	40	CENSUS: 3	DATE:	06/20/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Subashin Ranatunga		TIME COMPLETED:	03:15 PM

NARRATIVE

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At 9:00 AM on June 20^th, 2023 Licensing Program Analysts (LPAs) Mandie Goodwin and Jeremey McClain met with Director Subashini Ranatunga for the purpose of an unannounced 1 year required inspection. LPAs toured the facility, at which time a census of 3 infants supervised by one staff member was observed. There is a toddler option under the infant license and children were over 18 months. All individuals subject to criminal background review have obtained clearance.

LPAs observed the appropriate postings were visible to parents and children were signed in and out of the center using a digital application. There is at least one functioning smoke detector and carbon monoxide detector in the building. LPA observed a current roster. LPAs advised director that emergency disaster drills must be conducted every six months.

All furnishings in the classroom were in good condition. Infant diaper changing area is clean. Changing table was observed to be within arm’s reach from sink. There is a mat for the changing table with a vinyl surface that is at least 1 inch thick and has raised sides. Toys are appropriate size with no small parts for the safety of the infants. The infant classrooms appeared clean including the carpets and floor. Chemicals and cleaning materials were kept inaccessible to children.

Playground equipment is free of loose or sharp parts. LPAs observed that the squares used as resilient material were in need of repair and that the squares were separating leaving large gaps that could be a tripping hazard and exposed foam. Director stated that they have contacted a company for replacement and that children are using the other side that is in better condition. Outdoor shade was observed to be provided by canopies, trees, and sides of buildings. There are no firearms, poisons, or bodies of water on the premises.

All present staff files were reviewed. LPA reviewed staff transcripts and observed all staff being utilized as teachers were qualified. LPA observed a current Mandated Reporter certificate for each staff and director was reminded the certificate must be renewed every two years and can be renewed at mandatedreporterca.com.

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Mandie Goodwin	TELEPHONE: (916) 639-2867
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

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 06/20/2023 02:56 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: LITTLE BLOSSOM MONTESSORI SCHOOL, INC.	FACILITY NUMBER: 343613062
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/20/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101238.2(d)(2)

Outdoor Activity Space

(d) The surface of the outdoor activity space shall be maintained: (2) Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above by having big spaces between the square cushioning outside which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/04/2023
	Plan of Correction
1 2 3 4	Director will schedule a company to come replace the ground material and will send confimation of appointment to LPA by POC date.

Type B

Section Cited

CCR

101429(a)(2)(B)

Responsibility for Providing Care and Supervision for Infants

(B) Staff shall physically check on sleeping infant(s) every 15 minutes and document the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review and interview, the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/04/2023
	Plan of Correction
1 2 3 4	Director will send LPA proof of completing 15 minute sleep checks.

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: Mandie Goodwin	TELEPHONE: (916) 639-2867
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/20/2023 02:56 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: LITTLE BLOSSOM MONTESSORI SCHOOL, INC.	FACILITY NUMBER: 343613062
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/20/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101419.2(a)

Infant Needs and Services Plan

(a) Prior to the infant's first day at the center, the infant care center director or assistant director shall complete a needs and services plan for the infant. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review and interview, the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/04/2023
	Plan of Correction
1 2 3 4	Director will send the 3 needs and service plans to LPA.

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: Mandie Goodwin	TELEPHONE: (916) 639-2867
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: LITTLE BLOSSOM MONTESSORI SCHOOL, INC.	FACILITY NUMBER: 343613062
	VISIT DATE: 06/20/2023

NARRATIVE

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LPA observed proof of immunizations for the staff and all required documentation was present in the files. At least one staff had a current Pediatric CPR and First Aid certification.
LPA reviewed two student files and did not observe a needs and services plan for the children in the toddler option which is under the infant license. LPAs additionally did not observe that 15 minute sleep checks were being conducted. Director stated that she was not aware that these forms had to completed once the children moved up to the toddler program.

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.

This facility provides 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

LPA discussed Assembly Bill 2370, which will require licensed Child Care facilities to test their water for excessive amounts of lead. Testing will be required beginning January 1st, 2020 to January 1st, 2023 and must be conducted every five years from initial testing.

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 is cited on LIC 809-D. Appeal rights were provided. Exit interview was conducted and report was reviewed with the director Subashini Ranatunga.

SUPERVISOR'S NAME: Seychelle De Luca	TELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Mandie Goodwin	TELEPHONE: (916) 639-2867
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

LIC809 (FAS) - (06/04)

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