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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364842076
Report Date: 03/14/2023
Date Signed: 03/14/2023 02:52:42 PM


Document Has Been Signed on 03/14/2023 02:52 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:ST. MARY'S MONTESSORI SCHOOLFACILITY NUMBER:
364842076
ADMINISTRATOR:MARTINEZ DESERIEFACILITY TYPE:
830
ADDRESS:6880 N VICTORIA WINDROWS LOOPTELEPHONE:
(909) 200-2727
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91739
CAPACITY:28CENSUS: 20DATE:
03/14/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:45 AM
MET WITH:Deserie Martinez/directorTIME COMPLETED:
03:30 PM
NARRATIVE
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On 3/14/23 at 12:45 pm, Licensing Program Analyst (LPA) Patricia Berry conducted a subsequent complaint investigation. LPA met with director Deserie Martinez and was granted access into the facility. LPA toured facility and took a census.

During the course of a complaint investigation, staff stated a child was left unattended in a classroom closet, absent of supervision. Staff stated on 2/16/23, a staff member retrieved personal items from the classroom closet prior to going on break. Staff stated, after retrieving the items, the staff member closed and locked the closet door behind them.

Staff stated after approximately 2 minutes, other staff heard crying from the closet. Staff stated after opening the closet, they discovered a child inside. Administration staff admitted to not reporting the incident to Community Care Licensing nor the child’s guardians.

This is a violation of California Code of Regulations, 101212 (d) Title 22, Division 12. See 809D for deficiency.

An exit interview was conducted, and appeal rights discussed. LPA Berry provided facility representative with a copy of this report, notice of site visit, and appeal rights.

A copy of this report must be made available to the public upon request for three years.

SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Patricia BerryTELEPHONE: (951) 782-4952
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2023
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 03/14/2023 02:52 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: ST. MARY'S MONTESSORI SCHOOL
FACILITY NUMBER: 364842076

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/17/2023
Section Cited

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Reporting Requirements (d) Upon the occurrence, during the operation of the child care center of any of the events... a report shall be made to the Department... within the Department's next working day...
This requirement was not met as evidenced
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Administrator will submit the UIR to CCL and will also inform the parents and send both UIR's and parent notification of the incident to CCL by 3/17/23.
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Based on administration staff admitted to not reporting the incident to Community Care Licensing nor the child’s guardians

This is a potential risk to the health and safety of children in care
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 Director stated she will also have a training on reporting requirements and will send list of participants and topics to CCL by 3/15/23.

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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: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Patricia BerryTELEPHONE: (951) 782-4952
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2023
LIC809 (FAS) - (06/04)
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