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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364830892
Report Date: 07/26/2022
Date Signed: 07/26/2022 03:21:50 PM


Document Has Been Signed on 07/26/2022 03:21 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501



FACILITY NAME:MONTESSORI ACADEMY OF CHINOFACILITY NUMBER:
364830892
ADMINISTRATOR:DE SILVA, MAVANANEFACILITY TYPE:
850
ADDRESS:4511 RIVERSIDE DRIVETELEPHONE:
(909) 591-3937
CITY:CHINOSTATE: CAZIP CODE:
91710
CAPACITY:60CENSUS: 31DATE:
07/26/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Thushara De Silva, Director
Ariana Ramos, Assistant Director		TIME COMPLETED:
03:30 PM
NARRATIVE
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On 07/26/2022 Licensing Program Analysts (LPAs) Rachel Zeron and Kay Phillips visited the facility for another purpose. The facility was toured, a census was taken, and files were reviewed. LPAs met with the Director, Thurshara De Silva, and the Assistant Director, Ariana Ramos. While reviewing staff files, one of the staff members received a write-up for a child being left unattended in the classroom on 06/03/2022. Additionally, the incident was not reported to the Department. Both incidents are in violation of the regulations as outlined in Title 22.

Please see LIC 809D for deficiencies. A Civil Penalty was assessed.

LPA Zeron provided the resource of the County's Child Care Resource and Referral center.

Exit interview conducted and report was reviewed with the Director, Thurshara De Silva, and Assistant Director, Ariana Ramos.



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.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Karrene TurnerTELEPHONE: 951-970-1161
LICENSING EVALUATOR SIGNATURE:
DATE: 07/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/26/2022
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 07/26/2022 03:21 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501


FACILITY NAME: MONTESSORI ACADEMY OF CHINO
FACILITY NUMBER: 364830892

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/27/2022
Section Cited

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Providing Care and Supervision...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 was not met as evidenced by...
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LPA Zeron observed a written statement in staff members file regarding a child being left unattended in the classroom on 06/03/2022. This is an immediate risk to Health, Safety & Personal Rights to the children in care.
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Type B
08/02/2022
Section Cited

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Reporting Requirements...Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department (1) Events reported shall include the following: (C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child.
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This requirement was not met as evidenced by...

Both the Director and the Assistant Director confirmed they did not report the incident of a child being left unattended on 06/03/22.This is a potential risk to Health, Safety & Personal Rights 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: Aaron RossTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Karrene TurnerTELEPHONE: 951-970-1161
LICENSING EVALUATOR SIGNATURE:
DATE: 07/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/26/2022
LIC809 (FAS) - (06/04)
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