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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343619934
Report Date: 12/13/2023
Date Signed: 12/13/2023 01:03:03 PM


Document Has Been Signed on 12/13/2023 01:03 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:ELK GROVE MONTESSORI SCHOOL (PS)FACILITY NUMBER:
343619934
ADMINISTRATOR:NELSON, SARAFACILITY TYPE:
850
ADDRESS:8842 WILLIAMSON DRIVETELEPHONE:
(916) 685-6540
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:107CENSUS: 71DATE:
12/13/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Danielle LouieTIME COMPLETED:
01:35 PM
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Licensing Program Analysts (LPAs) Jennie Tedlos met with Admin Assistant, Danielle Louie for the purpose of an unannounced annual inspection. Facility hours of operation are Monday-Friday 7AM-6PM. There were 71 children present during today's inspection. LPA reviewed the sign in/out app and observed that the children are properly signed in.
LPA toured the facility inside and out. LPA observed to make sure that hazardous items (disinfectants, cleaning solutions etc.) were inaccessible to children in care. Upon inspecting the M4 classroom, LPA observed disinfecting wipes and Raid underneath an unlocked cabinet underneath the bathroom sink. LPA showed Admin Assistant and the items were put away in the proper areas. LPA reviewed staffing ratios, first aid supplies, furniture, equipment, fire drills and drinking water. LPA observed all required forms to be posted. LPA observed functioning carbon monoxide and smoke alarms. There are adequate toys and equipment available for children. Outdoor play area was toured, and equipment appears to be in good condition and there is sufficient cushioning under the play structure. Facility provides AM and PM snack to children in care. All food is prepared on site. Kitchen was toured at the time of inspection.

LPA reviewed children’s and staff files. LPA observed health screening reports with TB test and required MMR and TDAP vaccines. At least one staff member present today has current Pediatric CPR and First Aid. LPA observed AB1207 Mandated Reporter training certificates for all staff. The site supervisor was reminded to renew the course every 2 years through www.mandatedreporterca.com website.
Admin Assistant was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
REPORT CONTINUED ON SUBSEQUENT PAGE, 809 C
SUPERVISOR'S NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR NAME: Jennie TedlosTELEPHONE: (916) 936-7763
LICENSING EVALUATOR SIGNATURE:
DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/13/2023
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 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ELK GROVE MONTESSORI SCHOOL (PS)
FACILITY NUMBER: 343619934
VISIT DATE: 12/13/2023
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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. LPA did not observe proper labeling of the medications stored at the facility and observed one expired medication. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA referred Admin Assistant to the Department website for lead: https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information .



Admin Assistant was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.



Report Continues on to 809-C...
SUPERVISOR'S NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR NAME: Jennie TedlosTELEPHONE: (916) 936-7763
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ELK GROVE MONTESSORI SCHOOL (PS)
FACILITY NUMBER: 343619934
VISIT DATE: 12/13/2023
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Two Type A deficiencies are being cited based on LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22, see LIC809D. Two violations regarding the Physical Plant of the facility will be assessed.

Upon receipt of Type A citations, facility shall post and provide copies of the LIC 809D for parents/guardians of children currently in care and for parents/guardians of newly enrolled children for the next 12 months. Facility must also keep the signed LIC 9224, Acknowledging Receipt of Licensing Reports LIC 809D in each child's files.



An exit interview was conducted, and Plans of Correction were reviewed and developed with the Admin Assistant. A copy of this report and appeal rights were discussed and left with Admin Assistant.
SUPERVISOR'S NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR NAME: Jennie TedlosTELEPHONE: (916) 936-7763
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4
Document Has Been Signed on 12/13/2023 01:03 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827


FACILITY NAME: ELK GROVE MONTESSORI SCHOOL (PS)
FACILITY NUMBER: 343619934

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101226(e)(1)
Health-Related Services
(e) In centers where the licensee chooses to handle medications: (1) All prescription and nonprescription medications shall be centrally stored in accordance with the requirements specified below:

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 in 4 out of 4 stored children's medications. The children's medications were not properly labeled with the original prescribed prescription label and one of the medications was expired which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/20/2023
Plan of Correction
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The facility will obtain the original prescription labels for the medications which indicate the child's name, the prescription name, and the expiration date. The facility will email LPA photos of the prescriptions with the correct prescription labels.
Type A
Section Cited
CCR
101238(g)
Buildings and Grounds
(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children.

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. One package of disinfecting wipes and one spray can of Raid were found in an unlocked cabinet underneath a classroom's bathroom sink which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/20/2023
Plan of Correction
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The chemicals were put away during the inspection. The facility will conduct a staff training within a week of
the citation, which will include staff ensuring hazardous materials are properly stored. The facility will send LPA the signatures of all staff members who attended the training before the POC due date, 12/20/23.
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: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR NAME: Jennie TedlosTELEPHONE: (916) 936-7763
LICENSING EVALUATOR SIGNATURE:
DATE: 12/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/13/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4