376700138-3-17-2022-51-CC-GCUS-CCLNBJ-20220317101912

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376700138
Report Date: 03/17/2022
Date Signed: 03/17/2022 10:19:17 AM

Document Has Been Signed on 03/17/2022 10:19 AM - 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	CARMEL VALLEY MONTESSORI SCHOOL		FACILITY NUMBER:	376700138
ADMINISTRATOR:	HOLLY ROSA		FACILITY TYPE:	850
ADDRESS:	3800A MYKONOS LANE		TELEPHONE:	(858) 720-2181
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92130
CAPACITY:	94	CENSUS: 0	DATE:	03/17/2022
TYPE OF VISIT:	Case Management - Deficiencies	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Karla Contillo, Assistant Teacher		TIME COMPLETED:	10:30 AM

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 March 17, 2022 at 9:15 a.m. Licensing Program Analyst (LPA) Leilani Curtis conducted an unannounced case management inspection. Upon arrival LPA met with Assistant Teacher Karla Contillo and proceeded to tour the facility. There were no children present. Four staff members including Ms. Contillo were working in the facility. LPA spoke with Director Holly Rosa via telephone while at the facility. Carmel Valley Montessori School is located on the grounds of Carmel Valley Middle School. On 12/14/21 the administrative team at Carmel Valley Middle School received a report about threatening language written on campus. The administrative team found it to be a serious threat and contacted the police department. The director states that the facility was placed into "lock down status" from 2:45 p.m.-3:45 p.m. The director did not notify Community Care Licensing of the incident within the Department's next working day nor was a written report of the incident submitted within seven days of the date of occurrence. The director states that she did not report the incident to Community Care Licensing because she was not aware of the reporting requirement. The parents of children enrolled at the facility were notified of the incident via email on 12/15/21. See LIC809D for cited deficiency. An exit interview was conducted with the Director via phone and Ms. Contillo. Appeal Rights (LIC 9058 1/16) were discussed. Ms. Contillo's signature on this form acknowledges receipt of these rights. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS. LPA observed Ms. Contillo post notice of site visit.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace Curtis	TELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2022

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 03/17/2022 10:19 AM - 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, 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: 03/17/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/31/2022 Section Cited	1 2 3 4 5 6 7	101212(d)(1)(C) Reporting Requirements: (d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.(1) Events reported shall include the following:(C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child. This requirement was not met as evidenced by:
	8 9 10 11 12 13 14	Based on LPA’s interview with Director, the director failed to notify the Department of the unusual incident that occurred on 12/14/21 wherein the facility went into "lock down status" due to a police investigation at the adjacent middle school. This poses a potential 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 Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace Curtis	TELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2022

LIC809 (FAS) - (06/04)

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