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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700060
Report Date: 11/05/2021
Date Signed: 11/05/2021 12:45:07 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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:MONTESSORI SCHOOL OF OCEANSIDE #2 - INFANTFACILITY NUMBER:
376700060
ADMINISTRATOR:MENDOZA, SYLVIAFACILITY TYPE:
830
ADDRESS:4760 OCEANSIDE BLVD., #B10TELEPHONE:
(760) 724-8955
CITY:OCEANSIDESTATE: CAZIP CODE:
92056
CAPACITY:22CENSUS: 16DATE:
11/05/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:17 PM
MET WITH: Silvia MendozaTIME COMPLETED:
12:58 PM
NARRATIVE
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A case management visit was made today. During the visit, Licensing Program Analyst O. Cameron observed the following Title 22 code of regulation deficiencies:

See LIC 809-D for deficiencies.

An exit interview was conducted, a copy of this report ,and appeals rights were given to the Director Sylvia Mendoza

A copy of this report was provided along with a notice of site visit.
SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Otsanya CameronTELEPHONE: (951) 970-1388
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021
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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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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: MONTESSORI SCHOOL OF OCEANSIDE #2 - INFANT
FACILITY NUMBER: 376700060
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/05/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/15/2021
Section Cited

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Infant Care Food Service
(h) Infants who are unable to hold a bottle shall be held by a staff person or other adult for bottle feeding. At no time shall a bottle be propped for an infant.

This requirement was not met as evidenced by:
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Based on LPA's observation, licensee did not ensure infant care food service was followed. LPA observed 1 infant resting on a boppy pillow with a bottle propped in the mouth (feeding). Two staff were present in the room attending to 7 other infants.This poses a potential risk to 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: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Otsanya CameronTELEPHONE: (951) 970-1388
LICENSING EVALUATOR SIGNATURE:
DATE: 11/05/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/05/2021
LIC809 (FAS) - (06/04)
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