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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343616551
Report Date: 04/04/2022
Date Signed: 04/04/2022 03:40:38 PM


Document Has Been Signed on 04/04/2022 03:40 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:COUNTRYHILL MONTESSORIFACILITY NUMBER:
343616551
ADMINISTRATOR:WALKER, REONNAFACILITY TYPE:
850
ADDRESS:7048 SUNRISE BLVD.TELEPHONE:
(916) 728-2929
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:102CENSUS: 58DATE:
04/04/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Anna RoyalTIME COMPLETED:
03:50 PM
NARRATIVE
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At 9:40 a.m. on Monday, April 4th, 2022, Licensing Program Analyst (LPA) Karyn Guerra and Licensing Program Manager (LPM) Seychelle De Luca, met with Director, Anna Royal, for the purpose of a case management inspection. A census was conducted where 8 toddler children were observed supervised by 2 staff, and 50 preschool children were observed supervised by 7 staff. Additional administrative staff were present at the facility. Staff Alexandria Frazier, Anna Royal, and Elaheh Salehi were observed working in the facility without a fingerprint clearance. This poses an immediate risk to the health and safety of children in care. This is a repeat violation. A civil penalty was assessed.

A file review was conducted. Staff files were observed to be incomplete. This poses a potential risk to the health and safety of children in care.

Title 22 deficiencies are cited on the subsequent pages of this report. Director acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 809D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee. LIC 9224 and Appeal Rights were provided. Director's signature on this report acknowledges receipt of these rights. This report was reviewed with the Director. An exit interview was conducted. A Notice of Site Visit was provided and shall remain posted for a period of 30 days for parental review.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2022
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 3


Document Has Been Signed on 04/04/2022 03:40 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: COUNTRYHILL MONTESSORI
FACILITY NUMBER: 343616551

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/05/2022
Section Cited

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CRIMINAL RECORD CLEARANCE: 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. This requirement was not met as evidenced by:
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Based on observations Staff Alexandria Frazier, Anna Royal, and Elaheh Salehi were present at the facility without a fingerprint clearance. This poses an immediate risk to the health and safety of 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: 04/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3


Document Has Been Signed on 04/04/2022 03:40 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: COUNTRYHILL MONTESSORI
FACILITY NUMBER: 343616551

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/04/2022
Section Cited

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PERSONNEL RECORDS: The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee...This requirement was not met, as evidenced by:
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Based on file review, several staff files were missing required documents including health screening, documentation of educational background and experience, proof of immunizations and mandated reporter training certificates. This poses a potential risk to the health and safety of 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: 04/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3