394500266-3-4-2022-53-CC-SWIS-CC7UUF-20220304145328

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 394500266
Report Date: 03/04/2022
Date Signed: 03/04/2022 02:53:37 PM

Document Has Been Signed on 03/04/2022 02:53 PM - 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME:	MONTESSORI ON THE PRAIRIE		FACILITY NUMBER:	394500266
ADMINISTRATOR:	TENNAKOON, SHANIKA		FACILITY TYPE:	840
ADDRESS:	89 WEST 7TH STREET		TELEPHONE:	(209) 831-7872
CITY:	TRACY	STATE: CA	ZIP CODE:	95376
CAPACITY:	9	CENSUS: 5	DATE:	03/04/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:25 AM
MET WITH:	Shankia Tennakoon		TIME COMPLETED:	03:00 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 March 4, 2022 at 11:25 AM, Licensing Program Analyst (LPA) Stacey Williams met with Facility Representative for the purpose of an unannounced required 1 Year annual inspection. Program hours are Monday through Friday 7:30AM-5:00PM. Facility has an outdoor waiver on file. Upon arrival, LPAs observed (5) five children supervised by (1) one staff. Criminal record clearances have been verified. LPA conducted a health and safety inspection for all areas accessible to children. Staff stated there are no poisons on the premises. Toxic and hazardous items are inaccessible to children. Furniture and equipment are in good condition. LPA observed a functional smoke/carbon monoxide detector and a fully charged 2A :10BC fire extinguisher. The floors appeared clean throughout the facility. Outdoor play area is free from dangerous conditions and playground equipment is securely anchored to the ground. Facility has bark under the play equipment to absorb falls. Program provides a morning and afternoon snack. Children bring their own lunches. Menu was posted at the main entrance of the facility. Facility offers drinking water by utilizing a water dispenser where each child’s individual cup is filled. Sign in/out sheet are done electronically. Five child files were reviewed. Each child’s file contained an emergency card, and a medical assessment. Files for staff who were present at the facility were reviewed. Staff have a criminal record clearance, health screening report, immunization records, and documentation of their educational background, training, and/or experience. Mandated reporter training and CPR/First Aid certification was expired for the staff file that was reviewed. LPA reviewed the Department's inspection authority and discussed with staff any changes that may occur regarding Director/Site Supervisor or an employee acting in the director's absence must be reported to department within 10 working days. Report continues on 809-C

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Stacey Williams	TELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: MONTESSORI ON THE PRAIRIE	FACILITY NUMBER: 394500266
	VISIT DATE: 03/04/2022

NARRATIVE

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Facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Per facility representative there are no children that require medication. Facility has an Incidental Medial Service Plan on file. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Title 22 deficiencies were observed during today's inspection and will be cited on subsequent page, LIC 809D.

Exit interview conducted and report was reviewed with the Facility Representative, Shanika Tennakoon. A notice of site visit was given and must remain posted for 30 days. Appeal rights were provided.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Stacey Williams	TELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/04/2022 02:53 PM - 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: MONTESSORI ON THE PRAIRIE	FACILITY NUMBER: 394500266
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/04/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 1 out of 1 staff files reviewed which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/04/2022
	Plan of Correction
1 2 3 4

Type B

Section Cited

CCR

101216(f)

Personnel Requirements

(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 1 out of 1 staff files reviewed which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/04/2022
	Plan of Correction
1 2 3 4

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: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Stacey Williams	TELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2022

LIC809 (FAS) - (06/04)

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