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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343614059
Report Date: 03/11/2020
Date Signed: 03/11/2020 02:09:32 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:
343614059
ADMINISTRATOR:PHILLIPS, FELICIAFACILITY TYPE:
850
ADDRESS:2075 ARENA BLVDTELEPHONE:
(916) 515-0550
CITY:SACRAMENTOSTATE: CAZIP CODE:
95834
CAPACITY:165CENSUS: 89DATE:
03/11/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Lucky RanatungaTIME COMPLETED:
02:30 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Christopher Bello and Mai Lor arrived at the facility at approximately 11:05am to amend a report previously dated 1/21/2020. During the inspection LPAs observed 21 children sitting in circle time alone with one teacher in the Blue Room placing the facility out of ratio at approximately 11:10am. At approximately 11:13am LPA observed another teacher walking into the Blue Room placing the room back into Teacher-Child ratios placing the room back into compliance. At approximately 11:18am LPA observed 13 children alone with one teacher in the Toddler 2 Room placing the facility out of Teacher-Child Ratios. At approximately 11:19am two staff walked into the Toddler Room with two additional children making the Ratio 15 children to two teachers and one assistant placing the room back into compliance. These are considered an immediate health and safety risk to the children in care.The facility was accessed a civil penalty due to a repeat violation within a 12 month period. Facility was given Type Acknowledgement forms that are to be signed by current parent of the facility and new parents for the next twelve months. LIC 9224 and Appeal Rights were provided. An exit interview was conducted and a Notice of Site Visit posted which must remain posted for 30 days.

Report continues on the next page.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Christopher BelloTELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2020
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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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: 343614059
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/11/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/12/2020
Section Cited

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A ratio of one fully qualified teacher (as specified in Section 101216.1(c)) and one aide for every 18 children in attendance in a preschool program is allowed when the aide meets the qualifications specified in Section 101216.2(d). This requirement was not met by evidence: LPAs observed two rooms out
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of Teacher-Child Ratio. This is considered as a immediate risk to 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: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Christopher BelloTELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:
DATE: 03/11/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/11/2020
LIC809 (FAS) - (06/04)
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