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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364845734
Report Date: 01/09/2020
Date Signed: 01/09/2020 03:30:55 PM

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:CHILDREN'S MONTESSORI SCHOOLFACILITY NUMBER:
364845734
ADMINISTRATOR:CHILDREN'S MONTESSORIFACILITY TYPE:
850
ADDRESS:328 WEST PHILLIPS STREETTELEPHONE:
(909) 988-7145
CITY:ONTARIOSTATE: CAZIP CODE:
91762
CAPACITY:36CENSUS: 0DATE:
01/09/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Jessica Carbajal and Yanping ZhangTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA's), Nelson Zuniga and Diana Brasel, toured proposed Preschool center, inside and out. This is change of ownership pre-licensing. The days and hours of operation will be: Monday through Friday from 6:30 AM to 6:00 PM. The following measurements were taken:

Preschool Indoor Activity Areas
LPA has determined that there is sufficient space to accommodate 34 children.

Preschool Bathroom Fixtures
3 toilets x 15 = 45 children
3 sinks x 15 = 45 children

Preschool Outdoor Activity Area:
LPA has determined that there is sufficient space to accommodate 34 children.

Limiting factor for preschool capacity is indoor space. Preschool capacity is limited to 34 children.
Continue on LIC809C
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Nelson ZunigaTELEPHONE: (951) 782-6634
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020
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 9
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: CHILDREN'S MONTESSORI SCHOOL
FACILITY NUMBER: 364845734
VISIT DATE: 01/09/2020
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The following was observed:
· Classrooms are adequately equipped with age and size appropriate furniture and equipment
· Water dispenser are used for indoor drinking water
· Playgrounds are enclosed by appropriate fences
· Outdoor activity areas are supplied with age and size appropriate equipment
· An adequate amount of cushioning material (rubber pad under the artificial grass) is in place under play equipment
· Adequate shade is provided, the shade structure appears to be coming undone.
· Drinking water is provided in the outdoor play areas by water dispenser
· Food preparation area is equipped with refrigerator, sink with hot and cold running water, storage area, utensils. There are no provisions of food supplies as of today.
· The office area is located in front entrance of facility and will serve as the isolation area for ill children temporarily until parents arrive, applicant will provide proof of area, with a picture.
· Staff bathroom will also be used as the isolation bathroom and is conveniently located to the isolation area
· Toxins are locked
· Medication will be stored in kitchen and will be secured in a locked box
· Facility is not currently providing IMS Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided an updated Plan of Operation that includes 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
· Medication administration forms were reviewed
· First Aid kit is complete

(Cont on 809C)
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Nelson ZunigaTELEPHONE: (951) 782-6634
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020
LIC809 (FAS) - (06/04)
Page: 2 of 9
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: CHILDREN'S MONTESSORI SCHOOL
FACILITY NUMBER: 364845734
VISIT DATE: 01/09/2020
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· Sign in/Sign out record was reviewed and meets regulation requirements
· Component II Orientation was completed during this inspection
· A review of staff records on 1/9/2020 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
· The applicant has been informed that all employees must be associated to the facility. If the licensee fails to have proof of a fingerprint clearance or fails to associate a previously cleared individual to the facility, a civil penalty of $100.00, per day the person has been present, will be assessed. The first violation is subject to the penalty for up to five days. If there is a subsequent violation in a 12-month period, the fine will continue for up to 30 days.
· The applicant was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809 or LIC9099) must be posted for 30 days.
· For more information on SIDS and Safe Sleep Environments, please visit:
California Department of Public Health – California SIDS Program: http://www.cdph.ca.gov/programs/SIDS/pages/default.aspx
AAP – Safe Sleep Campaign: http://www.healthychildcare.org/sids/html
AAP-Free Training: Reducing the Risk of SIDS in Early Education and Child Care: http://shop.aap.org/Reducing-the-Risk-of-SIDS-in-Early-Education-and-Child-Care
And Caring for our Children, Safe Sleep Practices and SIDS/Suffocation Risk Reduction: http://cfoc/nrckids/org/standardview/spccol/safe_sleep
v - SB 277 – Immunizations, Personal Beliefs Exemption, effective January 1, 2016 - it eliminates the exemption from existing specified immunization requirements based upon personal beliefs, and only allows an exemption from future immunization requirements deemed appropriate by the State Department of Public Health or a medical professional for medical reasons.
v - AB290 – Child Nutrition, effective January 1, 2016 - In accordance with California Health and Safety Code Section 1596.866 - each child care center shall have at least one person employed who was completed one hour of childhood nutrition training as part of the preventive health practices course or courses. Continue on LIC809C
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Nelson ZunigaTELEPHONE: (951) 782-6634
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020
LIC809 (FAS) - (06/04)
Page: 3 of 9
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: CHILDREN'S MONTESSORI SCHOOL
FACILITY NUMBER: 364845734
VISIT DATE: 01/09/2020
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v - SB792 – Immunization requirements for staff, volunteers, effective September 1, 2016 – In accordance with California Health and Safety Code Section 1596.7995(a)(1) - Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. If employees/volunteers are receiving the influenza vaccination they must do so between August 1 and December 1 of each year.
v AB605 – Child day care facilities, birth to school-age license; Effective January 1, 2021 - An act amending Sections 1596.76, 1596.955 and 1596.956 and adding Section 1596.951 to the Health and Safety Code to address requirements for a single license and extend the period for possible participation in the toddler programs. It requires the California Department of Social Services, in consultation with stakeholders, to adopt regulations on or before January 1, 2021, to create a Child Care Center license to serve infant, toddler, preschool, and school-age children. It also requires, before January 1, 2024, that all Child Care Centers transition to one-center licenses. Access to forms & Regulations for Child Care Centers online at www.ccld.ca.gov.

v AB2960 – Child care and development services, online portal – Effective June 20, 2022 - This bill requires the State Superintendent of Public Instruction (SSPI), within the California Department of Education (CDE), to develop and post on CDE's website a comprehensive child care and development services online portal for families and providers by June 30, 2022. Further, the bill would require the SSPI to submit a report to the Legislature by January 1, 2021, proposing plans for enhancements to the online portal and inclusive of a comprehensive implementation plan, based on recommendations from the workgroup.v Access to forms & Regulations for a Child Care Center are online at www.ccld.ca.gov. v Please subscribe at:

www.childcareadvocatesprogram@dss.ca.gov to receive Department updates. They will be sent directly to your e-mail account once you have set up an account. This website can also be accessed through www.ccld.ca.gov v The Duty Officer is available to answer questions Monday – Friday at 1-844-LET-US-NO (1-844-538-8766). Continue on LIC 809C

SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Nelson ZunigaTELEPHONE: (951) 782-6634
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020
LIC809 (FAS) - (06/04)
Page: 4 of 9
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: CHILDREN'S MONTESSORI SCHOOL
FACILITY NUMBER: 364845734
VISIT DATE: 01/09/2020
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 - AB2231 (2016) – Increased Civil Penalties, effective July 1, 2017 – For failing to correct a violation the civil penalty is increased to $100 per day for EACH violation until corrected; For failing to correct a repeated violation the civil penalty is increased to $250 immediately assessed , and $100 per day afterwards for EACH repeated violation until corrected; For an Immediate Risk violation the civil penalty is increased to $500 immediately assess, and $100 per day for EACH violation after that until corrected; For any repeated Immediate Risk violations the civil penalty is increased to $1,000 immediately assess, and $100 per day afterwards for EACH repeated violation until corrected. v NOTE: Repeat violations are defined as a violation of a previously cited statutory or regulatory Section and/or subsection within 12 months prior.
- AB2370 – Lead Exposure, day care facilities, effective January 1, 2019 - An act amending Sections 1596.866 and 1596.8661 and adding Sections 1596.7996 and 1597.16 to the Health and Safety Code for the education of risks and effects of lead exposure in child care facilities and for the testing of drinking water in licensed child care centers. Licensed providers have access to a document regarding lead toxicity prevention created in partnership with the California Department of Public Health (CDPH) to provide to parents/guardians of newly enrolled or reenrolled children with information on the following:
· Risks and effects of lead exposure
· Blood lead testing recommendations and requirements
· Options for obtaining blood lead testing, including any programs that offer free or discounted tests
This printable document (Lead Poisoning Facts) is located here as well as on the Child Care Licensing website. The bill also requires that that the Department add instruction on the prevention of lead exposure to the Preventative Health and Safety Training curriculum for providers licensed on or after July 1, 2020. Finally, it requires that all Child Care Centers, operating in a building constructed before January 1, 2010, shall have their drinking water tested for excessive lead levels, on or after January 1, 2020, but no later than January 1, 2023. Child Care Centers must thereafter test their drinking water every five years after the date of the initial test. The Department must adopt regulations in consultation with the State Water Resources Control Board for the implementation of the requirements for the testing of drinking water for lead in Child Care Centers by January 1, 2021. The regulations shall include requirements to ensure the collection and submission of valid water samples.
v Effective January 1, 2017 – Children under 2 years of age shall ride in a rear-facing car seat unless the child weighs 40 or more pounds OR is 40 or more inches tall. For additional information regarding car seat laws see www.chp.ca.gov Continue on LIC 809C
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Nelson ZunigaTELEPHONE: (951) 782-6634
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020
LIC809 (FAS) - (06/04)
Page: 5 of 9
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: CHILDREN'S MONTESSORI SCHOOL
FACILITY NUMBER: 364845734
VISIT DATE: 01/09/2020
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An exit interview was conducted and during the interview, the licensee/Applicant confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

The following items need to be completed/corrected prior to a license being issued:

1. The Isolation area needs to be identified and provide pictures of area
2. There are no food provisions
3. The electrical outlets where the refrigerator is connected has a broken cover and has wire sticking out of the box.
4. All window seals shall be cleans as they appeared to have dirt and dead small insects.
5. There is a sink that is no operable.
6. The gardening around the outside of facility will be done and applicant will provide proof.
7. The shade structure is made out of wood. It appears that some of the joint areas the wood is coming apart, in the middle the wood is warp.
8. There is a pipe that is protruding from the wall.
9. There is an opening in the rear of the facility on the ground next to the outside wall of facility. This opening shall be sealed.
10. The outdoor furniture, play toys and play structure need to be cleaned. At the present there is dirt and spider web on items.
11. There is an area near the back door on the chain link fence that had a tear. There are currently iron pieces holding chicken wire. This iron pieces could be a hazard to the children in care by how the are in place.
12. Throughout the play yard there is furniture that per applicant will need to be throw in garbage.
13. The metal rail to the back stairs is rusted. Per applicant it will be painted and the children table.
(Continue on LIC809C)
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Nelson ZunigaTELEPHONE: (951) 782-6634
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020
LIC809 (FAS) - (06/04)
Page: 6 of 9
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: CHILDREN'S MONTESSORI SCHOOL
FACILITY NUMBER: 364845734
VISIT DATE: 01/09/2020
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14. PLEASE REFERRED TO LIC9218,. APPLICATION CHECKLIST FOR THE FOLLOWING:
Designation of Facility Responsibility, (LIC308) (A) is filled out for the director and other personnel authorized to act on behalf of the licensee. (B) The director has filled out one to delegate authority when absent.
15. Administrative Organization (LIC 309): shall be updated with current information.
16. Articles of Incorporation:
Provide Constitution and By Laws.
Provide board officer's names, titles, business and home addresses.
Name and address of those holding 10% or more shares
17. Monthly Operating Statement (LIC401)
All operating cost are indicated and reasonable
Rent, mortgage figures correspond with lease or mortgage payment agreement.
If breakfast or lunch is provided, figures on form shall be reasonable.
18. Personnel Report (LIC500)
Update to reflect current staff and indicate all positions at the center.
19. Job Descriptions
For all positions that are listed on the LIC500
The following shall be listed on each job description: Duties, responsibilities, minimum qualifications for each position shall be listed and line of supervision shall be included
20. Personnel Policies. The following shall be included in the personnel policies.
Employee Rights, LIC9052), Abuse reporting Procedures and requirements, Hiring practices and condition of employment and Work hours and shift.
21. In Service Training Plan:
Indicates what staff will receive training
Indicates who will give the training
Indicates the topics to be covered.
22. Control Of Property:
Copy of lease or rental agreement. (Continue on LIC809C)
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Nelson ZunigaTELEPHONE: (951) 782-6634
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020
LIC809 (FAS) - (06/04)
Page: 7 of 9
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: CHILDREN'S MONTESSORI SCHOOL
FACILITY NUMBER: 364845734
VISIT DATE: 01/09/2020
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23. Parent Handbook/Program Description/Admission Policies and Procedures/Schedule of Activities:
The following shall be included and updated.
Category and age of children accepted for care.
Days and hours of operation
Food Service Provisions (Meal and snack times)
Supplementary services if any
Field Trip Provisions
Transportation Arragements
Children and parents rigths
Immunization requirements.
Medical assessment and TB requirements
Medication and Policy/Plan
Services provided during a medical and dental emergency.
24. Admission Agreement: The following shall be updated/provided.
Description of basic services
Optional services
Payment provisions: Rate for basic service, Rate for optional Services, Payor, Due Date and frequency of payments.
Modification conditions
Refund policies
Termination policies
Rights of the Licensing Agency
25. Discipline Policies: Applicant shall provide the following:
Types of Disciplines and conditions under which they are to be used.
Types of Disciplines not permitted
Provisions for contacts/conferences with parent
Grounds for dismissal/removal. (Continue on LIC809C)
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Nelson ZunigaTELEPHONE: (951) 782-6634
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020
LIC809 (FAS) - (06/04)
Page: 8 of 9
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: CHILDREN'S MONTESSORI SCHOOL
FACILITY NUMBER: 364845734
VISIT DATE: 01/09/2020
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26. Sample Menu; The following shall be updated/provided.
One week's menu
Portion sizes included
Time of meals and snacks included
27. List of Furniture and Play Equipment. Shall be provided/updated.
Tables, chairs, mats, toys and all equipment shall be listed.
28. Orientation Training. Director and licensee shall attend component III orientation.
29. Financial Information Release and Verification (LIC404) shall be provided by applicant
30. Applicant Information (LIC)215 original document shall be provided with the original signature
31. Health Screening Report (LIC503): Director shall provide a report that covers her position as director and current within the past 12 months.
Immunization requirements for owner.

A fire clearance has been obtained for requested capacity of 36 however, the indoor space only accommodates only 34 children. Once all corrections have been made, with proof sent to licensing, the application will be submitted for approval with a maximum capacity of 34. As agreed upon by the applicant, all corrections are due within 30 days. If not received within 30 days from the date of this report, the application will be denied. An exit interview was conducted and a copy of this report was provided to the applicant on this date.

A copy of this report must be made available to the public for 3 years.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Nelson ZunigaTELEPHONE: (951) 782-6634
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020
LIC809 (FAS) - (06/04)
Page: 9 of 9