343619934-10-11-2019-53-CC-ASIA-BGUP57-20191011110015

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343619934
Report Date: 10/11/2019
Date Signed: 10/11/2019 11:00:21 AM

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:	ELK GROVE MONTESSORI SCHOOL (PS)		FACILITY NUMBER:	343619934
ADMINISTRATOR:	NELSON, SARA		FACILITY TYPE:	850
ADDRESS:	8842 WILLIAMSON DRIVE		TELEPHONE:	(916) 685-6540
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95624
CAPACITY:	107	CENSUS: 65	DATE:	10/11/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Admin. Assistant Misty Silver and Assistant Director Eunice Melara		TIME COMPLETED:	11:00 AM

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Licensing Program Analyst (LPA) Amy Silva met with Administrative Assistant Misty Silver and Assistant Director Eunice Melara for the purpose of an unannounced random annual inspection. Upon arrival, there were eleven staff and 65 children present. Facility hours of operation are Monday through Friday from 7:00 AM to 6:00 PM.

LPA toured classroom, restrooms, and outdoor play area. Toileting facilities are in safe, sanitary, and operating condition. The floors appeared clean throughout the facility. Toxic and hazardous items are inaccessible to children. Furniture and equipment are in good condition. All food was protected against contamination. Storage containers with solid waste have tight-fitting covers. Program provides morning snacks and afternoon snacks. Menus were posted. Drinking water was readily available to children both indoors and outdoors. Currently, 1 child in care require medications. LPA observed full legal signatures while reviewing the sign in and sign out sheets.

Four staff and four children's records were reviewed. Each child's file contained an emergency card and a medical assessment. At least one staff member present today has current Pediatric CPR and First Aid certification (exp. 4/2021).

All staff currently employed with the facility have a criminal record clearance, health screening report, immunization records, and documentation of the educational background, training, and/or experience. There are no firearms or bodies of water on the premises. LPA observed a functional carbon monoxide detector.

Report continues on 809-C

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Amy Silva	TELEPHONE: (916) 926-9100
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2019

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: ELK GROVE MONTESSORI SCHOOL (PS)	FACILITY NUMBER: 343619934
	VISIT DATE: 10/11/2019

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Facility is providing Incidental Medical Services. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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.

LPA provided and discussed Effects of Lead Exposure brochure and the revised CDPH 286 form for the documentation of immunization's.

This facility evaluation report was reviewed and discussed with Assistant Director. A Notice of Site Visit was provided and should remain posted for a period of 30 days for parental review. An exit interview was conducted and in the areas that were evaluated, no deficiencies were observed at the time of the inspection.

SUPERVISOR'S NAME: Maria Mayorga	TELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Amy Silva	TELEPHONE: (916) 926-9100
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2019

LIC809 (FAS) - (06/04)

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