376700281-8-27-2021-51-CC-NDIZ-C6AS3R-20210827133134

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376700281
Report Date: 08/27/2021
Date Signed: 08/27/2021 01:31:46 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:	MONTESSORI SCHOOL OF KEARNY MESA - INFANT		FACILITY NUMBER:	376700281
ADMINISTRATOR:	AMITHA PERUSINGHE		FACILITY TYPE:	830
ADDRESS:	3411 SANDROCK ROAD		TELEPHONE:	(858) 505-0332
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92123
CAPACITY:	16	CENSUS: 8	DATE:	08/27/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:40 AM
MET WITH:	Amitha Perusinghe		TIME COMPLETED:	02:00 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 8/27/21 @ 11:40am, LPA Nancy Diaz conducted an unannounced inspection. LPA met with Amitha Perusinghe, Site director. Observed present today were 8 infants with staff Maribel Cruz, Estela Pantaleon, Carashay Evans & Kinda Sancha. A tour of the facility was conducted with staff Teresa Sotelo. There is one classroom designated for infants. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. The licensee has not exceeded the conditions, limitations and capacity specified on the license. Children were observed to be visually supervised by a qualified teacher. At least one person is trained in CPR and Pediatric First aid was present today (Shantal Sanchez). The child care center was observed to be clean, safe, sanitary and in good repair to ensure the well-being of children, employees and visitors. Furniture and equipment are in good condition, free of sharp, loose or pointed parts. Disinfectants, cleaning solutions, medications or poisons are inaccessible to children. All toilets, handwashing facilities are in safe and sanitary operating condition. All floors are clean and safe. A carbon monoxide detector is maintained in the facility. An isolation area has been designated for children who becomes ill during the day. Menus are posted and visible to child’s authorized representative. Kitchen and food preparation areas are kept clean. All food and beverage are stored appropriately. Uncontaminated drinking water are readily available both indoors and out. CONTINUED...

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy Diaz	TELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2021

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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: MONTESSORI SCHOOL OF KEARNY MESA - INFANT	FACILITY NUMBER: 376700281
	VISIT DATE: 08/27/2021

NARRATIVE

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The surface of the outdoor activity space are maintained in a safe condition, and free of hazards. Playground equipment are in safe condition, free of sharp, loose or pointed parts. The areas around or under high climbing equipment are cushioned with material that absorbs a fall.

Children’s files were review. The person who signs the child in/out use their full legal signature and recorded the time of day. An emergency information is maintained for all children in care.

Staff files were reviewed. Staff have current physician’s report on file. Staff qualification are maintained that included educational background, training and or experience. Staff have completed the mandated reporter training. Staff have been immunized against pertussis, influenza and measles.

Infant changing tables have a padded surface not less than one inch thick. Infant changing tables have raised sides at least three inches high. Toys are observed to be safe, and did not have sharp points or edges or splinters or made of small parts that can be pulled off and swallowed. Facility maintains sufficient napping equipment. The infant facility have indoor/outdoor activity space that is physically separate from space used by child care center/school age components. Direct visual supervision are provided by staff at all times. Facility maintains infant sleeping plans. Infant individual feeding and needs and services plans are maintained. Nap documentations are maintained that included: infant’s name, date, time of each 15-minute check and initials of the person who conducted each check.

Type B deficiency was cited today. Type B deficiency if not corrected poses a potential risk to the health, safety or personal rights of children in care.

An exit interview was conducted with Ms. Amitha. A copy of this report and appeal rights were provided today.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy Diaz	TELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2021

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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: MONTESSORI SCHOOL OF KEARNY MESA - INFANT	FACILITY NUMBER: 376700281
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/27/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/10/2021 Section Cited	1 2 3 4 5 6 7	RESPONSIBILITY FOR PROVIDING CARE AND SUPERVISION FOR INFANTS. Staff shall physically check on sleeping infant(s) every 15 minutes and document... This regulation requirement was not met as evidenced by:
	8 9 10 11 12 13 14	Based on LPA's review of infant records, staff were only documenting 15-minute checks up to 1:45PM, no records were maintained past 1:45PM as the form used did not provide additional room for entry.	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: Nancy Diaz	TELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2021

LIC809 (FAS) - (06/04)

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