<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700138
Report Date: 01/12/2022
Date Signed: 01/12/2022 04:24:15 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:CARMEL VALLEY MONTESSORI SCHOOLFACILITY NUMBER:
376700138
ADMINISTRATOR:HOLLY ROSAFACILITY TYPE:
850
ADDRESS:3800A MYKONOS LANETELEPHONE:
(858) 720-2181
CITY:SAN DIEGOSTATE: CAZIP CODE:
92130
CAPACITY:94CENSUS: 62DATE:
01/12/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:35 PM
MET WITH:Holly RosaTIME COMPLETED:
04:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 1/12/22 at 3:35 p.m. Licensing Program Analyst (LPA) Leilani Curtis conducted an unannounced inspection. Upon arrival LPA met with Director Holly Rosa and proceeded to tour the facility. There were 62 children present with 7 staff members. The children were napping. Appropriate ratios were observed. One of the staff members (S1) is not associated to the facility. The director states that S1 is a substitute from "A Plus Subs" and has worked at the facility for one day, 1/12/22. The other six staff members have the required background clearances and are associated to the facility.

See LIC809D for cited deficiency. A $100.00 civil penalty has been assessed.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. A copy of the Fact Sheet - AB 633 Child Care Parent Notification Requirements and a copy of LIC 9224 was given to the director.

An exit interview was conducted with the director. Appeal Rights (LIC 9058 1/16) were discussed. A printed copy of this report as well as a printed copy of the appeal rights were provided and reviewed with the director at the conclusion of the inspection. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS. LPA observed the director post notice of site visit.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace CurtisTELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2022
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: CARMEL VALLEY MONTESSORI SCHOOL
FACILITY NUMBER: 376700138
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/12/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/13/2022
Section Cited

1
2
3
4
5
6
7
101170(e)(2) Criminal Record Clearance: (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:(2) Request a transfer of a criminal record clearance as specified in Section 101170(f)...This requirement was not met as evidenced by:
8
9
10
11
12
13
14
Based on LPA's record review, observation and interview with director, a substitute staff member (S1) worked at the facility on 1/12/22 without being associated to the facility. This poses an immediate health and safety risk to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7

1
2
3
4
5
6
7
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: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace CurtisTELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:
DATE: 01/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/12/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2