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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364842571
Report Date: 02/11/2022
Date Signed: 04/25/2022 08:46:52 AM


Document Has Been Signed on 04/25/2022 08:46 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 04/08/2022 09:34 AM

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

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*******THIS IS AN AMENDED REPORT TO AMEND THE DEFICIENCY REPORT ISSUED ON 2/11/22. THE FOLLOWING DEFICIENCY CITED ON 2/11/22 HAS BEEN DISMISSED.******

On this date and time, Licensing Program Analyst (LPA) Laura Mejorado conducted an unannounced case management inspection to follow-up on an Unusual Incident Report (UIR) submitted by the facility to the Riverside Child Care Regional Office on 1/25/22. During this inspection, LPA met with Assistant Director Sarah Romero. LPA toured the facility, took census and verified staff's criminal record clearances and association to facility.

During the inspection LPA observed an unclear staff member working in the infant room. See LIC809D for deficiency cited per California Code of Regulations Title 22, Division 12.

Due to additional information needed, this UIR needs further investigation.

An exit interview was conducted, and a Notice of Site Visit was provided and must be posted for 30 days.

The signature below acknowledges this information was reviewed with Assistant Director Sarah Romero.

SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Laura MejoradoTELEPHONE: 951-782-4200
LICENSING EVALUATOR SIGNATURE:
DATE: 04/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/20/2022
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 04/25/2022 08:47 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 04/08/2022 09:31 AM


Citations on this Visit Report are Under Appeal!

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 KIDS LAND ACADEMY
FACILITY NUMBER: 364842571

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/11/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type A
02/14/2022
Section Cited

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***THIS CITATION HAS BEEN DISMISSED AND AMENDED***
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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: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Laura MejoradoTELEPHONE: 951-782-4200
LICENSING EVALUATOR SIGNATURE:
DATE: 04/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/20/2022
LIC809 (FAS) - (06/04)
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