343622305-4-7-2022-03-CC-KOWS-CD9UNK-20220407154403

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343622305
Report Date: 04/07/2022
Date Signed: 04/07/2022 03:44:11 PM

Document Has Been Signed on 04/07/2022 03:44 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:	COUNTRY HILL MONTESSORI, INC.		FACILITY NUMBER:	343622305
ADMINISTRATOR:	BYRD, TANYA		FACILITY TYPE:	850
ADDRESS:	6131 KENNETH AVENUE		TELEPHONE:	(916) 969-2929
CITY:	FAIR OAKS	STATE: CA	ZIP CODE:	95628
CAPACITY:	60	CENSUS: 62	DATE:	04/07/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Tanya Byrd - Director		TIME COMPLETED:	04:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	An unannounced annual/random inspection is made today by Licensing Program Analyst Owens and Habtom. LPA Owens met with Tanya Byrd, Director. LPA's toured the facility including all activity and classroom spaces, restrooms, food service and outdoor play areas. Staff and children were spoken to during inspection. The following areas are in compliance during inspection: There are no bodies of water. Firearms and ammunition are not on the premises. Storage area for poisons is locked. Disinfectants, hazardous items and medications are inaccessible to children. Furniture and equipment are sufficient, age appropriate and in good repair. Fire drills are conducted according to Title -22 Regulations. The playground equipment and outdoor activity space is maintained and in good condition. There is adequate shade on the playground. Wood chips is being used as cushioning around the climbing equipment. Children's toilets, hand washing facilities are sanitary. Rooms are safe and clean. Carbon Monoxide detector is on the premises. Food preparation area is clean, food is protected from contamination, storage containers for solid waste are covered and all food or beverages are stored in covered containers at 45 degrees or less. The facility provides two snacks and parents provide their child's lunch. Drinking water is available both indoors and outside. Menus are posted. The facility is NOT in compliance with conditions and limitations specified on the license. Teacher/child ratios are maintained and adequate supervision was not being provided at all times during this inspection. There is adequate space for children belongings. Napping equipment are in good repair. Sign in/sign out sheets maintained. No excluded individuals are present. Facility Representative, Tanya Byrd, 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. Staff subject to a criminal record clearance or exemption are associated to the facility. Continued on next page.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina Owens	TELEPHONE: 916-263-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022

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 04/07/2022 03:44 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: COUNTRY HILL MONTESSORI, INC.	FACILITY NUMBER: 343622305
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/07/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

101229(a)(1)

Responsibility for Providing Care and Supervision

(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA Owens observation the licensee did not comply with the section cited above in that there were three children observed coming from the bathroom not escorted by staff; children were in bathroom alone and returned to classroom by themselves which poses an immediate health, safety or personal rights risk to persons in care. Form LIC 9224 was given and explained to Director at time of inspection.
	POC Due Date: 04/11/2022
	Plan of Correction
1 2 3 4	Director stated she will have an all staff meeting with staff about 100% supervison of children and escorting children to the restrooms. She will send CCL a copy of the all staff meeting agenda and sign in sheet. She will send this information to CCL on or before 4/11/2022. Director was informed if POC is not received by due date a civil penalty may be accessed.

Type A

Section Cited

CCR

101161(a)

Limitations on Capacity and Ambulatory Status

(a) A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA's observation the licensee did not comply with the section cited above in that when LPA's arrived at the facility there were 62 children present at the facility and the facility is licensed for a capacity of 60 children this poses an immediate health, safety or personal rights risk to persons in care. LPA's also observed a school age child napping with preschool children; therefore commingling was observed and this is an immediate risk to children. Form LIC 9224 was given and discussed at time of inspection.
	POC Due Date: 04/07/2022
	Plan of Correction
1 2 3 4	Director stated she will talk with parents that are scheduled to leave at a certain time and reschedule the departure time/date. The citation was cleared by some children were picked up by parents bring the facility into capacity of the license.

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: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina Owens	TELEPHONE: 916-263-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022

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: COUNTRY HILL MONTESSORI, INC.	FACILITY NUMBER: 343622305
	VISIT DATE: 04/07/2022

NARRATIVE

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First Aid/CPR reviewed and in compliance. Emergency information reviewed for some children. Staff records reviewed contain documentation of the educational background, training, and/or experience. Operating hours are Monday thru Friday; 7:00 AM to 6:00 PM.

LPA observed proof that all staff/ volunteers have met the requirements of SB 792.

LPA observed that all staff has completed the required mandated reporter training (AB 1207) at website: www.mandatedreporterca.com

LPA discussed the Effects of Lead Exposure brochure.

LPA provided the Community Care Licensing website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised licensee of their responsibility to stay current in regards to new regulations. LPA also included the email address for the children's advocacy program to stay current on new laws childcareadvocatesprogram@dss.ca.gov.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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

The following is cited per Title 22 Div. 12 of the CCR: (see page 2)
Copy of Appeal Rights left with Center Representative, Director, Tanya Byrd.

Upon receipt, licensee shall post and provide copies of the licensing report to parent/guardians of children in care and the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.
To order forms, etc. visit our website at www.ccld.ca.gov

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina Owens	TELEPHONE: 916-263-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022

LIC809 (FAS) - (06/04)

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