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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700963
Report Date: 03/06/2020
Date Signed: 03/06/2020 10:11:40 AM

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:VILLAGE MONTESSORI SCHOOLFACILITY NUMBER:
376700963
ADMINISTRATOR:PETRA WOODFACILITY TYPE:
830
ADDRESS:2606 JEFFERSON STREETTELEPHONE:
(760) 405-7800
CITY:CARLSBADSTATE: CAZIP CODE:
92008
CAPACITY:24CENSUS: 2DATE:
03/06/2020
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:28 AM
MET WITH:Edelaine TordecillasTIME COMPLETED:
10:30 AM
NARRATIVE
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LPA Nancy Diaz conducted an unannounced inspection in reference to deficiencies cited on 2/13/2020. Upon arrival LPA observed 2 infants with staff Melanie Smith and Mariana Ramirez. A tour of the facility was conducted. Mrs. Tordecillas (site director from another site) came to assist the analyst with the file review.

PIN 20-02-CCP (Coronavirus information and guidelines for Child Care settings) was provided to Mrs. Tordecillas today.

TYPE B DEFICIENCIES WERE CITED TODAY. REPEAT VIOLATION. Type B deficiencies if not corrected poses a potential risk to the health, safety or personal rights of clients in care. Civil penalty was also assessed.

An exit interview was conducted. Appeal rights were provided in writing.

LPA observed the Representative post the Notice of Site Visit in a prominent place. The Representative states it is understood that this notice must be posted for 30 days.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020
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 3
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: VILLAGE MONTESSORI SCHOOL
FACILITY NUMBER: 376700963
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/13/2020
Section Cited

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H & S 1596.7995. Effective September 1, 2016, a person may not be employed or volunteer at a child care center unless he or she has been immunized against influenza, pertussis and measles.
This regulation was not met as evidenced by:
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A file review was conducted and it revealed that Mrs. Crisman is missing immunization for Measles.
Staff Mariana Ramirez does not have pertussis immunization record on file.
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Type B
03/13/2020
Section Cited

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PERSONNEL REQUIREMENT
Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.
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This regulation requirement was not met as evidenced by:
Physician's report on record for Melanie Smith was dated 7/20/2018. Staff Mariana Ramirez did not have a Physician's report on file.
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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: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2020
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: VILLAGE MONTESSORI SCHOOL
FACILITY NUMBER: 376700963
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/13/2020
Section Cited

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Infant Care Center Director Qualifications and Duties
If the absence is for more than 30 consecutive calendar days, the substitute director shall meet the qualifications of a director.
This regulation was not met as evidenced by:
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Mrs. Crisman's stated that her former director Petra Wood left employment in January 2020. Facility has not designated a director or a substitute in the absence of a director.
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Type B
03/13/2020
Section Cited

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H & S Section 1596.8662 create requirements for mandated child abuse reporter training. Applicants, licensees, and facility employee may meet this requirement free of cost by accessing the online training module provided on the Department of Social Services, Mandated Reporter Training Website: www.mandatedreporterca.com (effective 1/1/2018).
This requirement was not met as evidenced by:
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File review conducted by LPA revealed that staff Mariana Ramirez has not completed the required Mandated Reporter course.
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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: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3