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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 401710931
Report Date: 08/05/2022
Date Signed: 08/05/2022 02:33:35 PM


Document Has Been Signed on 08/05/2022 02:33 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117



FACILITY NAME:ARROYO GRANDE MONTESSORI SCHOOLFACILITY NUMBER:
401710931
ADMINISTRATOR:MICHAEL MILLERFACILITY TYPE:
850
ADDRESS:216 OAK STREETTELEPHONE:
(805) 473-2979
CITY:ARROYO GRANDESTATE: CAZIP CODE:
93420
CAPACITY:23CENSUS: DATE:
08/05/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Elizabeth SilvaTIME COMPLETED:
02:30 PM
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On 8/5/22, at 10:30 AM, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced One Year required Inspection of the abovementioned Child Care Center (CCC). LPA met with Elizabeth Silva , Assistant Director of the CCC and explained the purpose of the inspection. LPA, in the company of Assistant Director, toured the interior and exterior of the CCC. The CCC operates from 7:30 AM to 3:30 PM, Monday - Friday. The preschool uses a great room and an outdoor play area for child care services. LPA observed 15 children on site at the time of the inspection, along an Assistant/Employee Andrew Silva (cleared and associated) providing supervision and care.

The CCC's classrooms to be clean and well organized. The classroom has age appropriate toys and furnishings available for children in care. LPA observed the restroom area used by children in care to be clean and free of toxins. The restroom has two entries. One entry has secure swing doors which barricade the children from accessing the area by stairs. The other entry has no stairs. The CCC has an operable refrigerator which contained food and beverages. LPA notes children in care bring lunches from their homes, while the CCC provides snacks. CCC staff ensure lunches brought from home are viewed and contain food from the essential food groups as opposed to junk foods. The CCC affords the children filtered water both inside the CCC and in the exterior. The CCC does not use facility drinking water sources (i.e. fountains) and the Assistant Director was reminded of the need to test the CCC water sources for lead containments. LPA observed a facility menu posted as well as required licensing documents near the CCC's main entry/exit. The CCC uses an electronic sign in and sign out system for the facility. LPA reviewed a sampling of entries and notes the information is satisfactory.

LPA observed a carbon monoxide detector in the CCC which was tested (11:42 AM) and found to be operable. Disinfectants and cleaning solutions are observed on an elevated shelf in the CCC's restroom area which is inaccessible to children in care. Medication is on the premises is stored in an elevated cabinet and inaccessible to children in care. At 11:30 AM, LPA observed a kitchen knife in an unsecured lower drawer.
(CONT. 809-C)
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:
DATE: 08/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/05/2022
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 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: ARROYO GRANDE MONTESSORI SCHOOL
FACILITY NUMBER: 401710931
VISIT DATE: 08/05/2022
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 The observation was made when the Assistant Director was showing LPA the contains of the lower cabinet drawer. LPA notes the drawer had no locks and the drawer where the knife was observed was not inaccessible to children in care. Further nothing barricaded the children's access to the drawer Assistant Director remove the knife from the lower drawer and placed the knife in an elevated cabinet which was inaccessible to children in care.

The CCC’s outdoor playground area, which is comprised of natural grass, and rubber chip footing is enclosed by chain linked fencing. The fence’s entry/exit gates are secured. LPA observed age appropriate toys and play equipment in the play area. The toys and play equipment are in suitable condition and free of sharp, loose or pointed objects. LPA observed the play structures in the playground area have adequate cushioning materials (i.e. rubber chips) to absorb falls and shade covering in the area provided by tree and building overhangs. LPA observed a shed in an excluded area of the outdoor which contains CCC supplies. The shed is secure. No bodies of water were observed on site. LPA reminded Assistant Director to replace play equipment when it begins to degrade and is not of good repair. Waste receptacles with tight fitting covers were observed throughout the center.

The records of staff and children's on site was reviewed. The children’s records were complete and found to contain emergency contact information and well as immunization records. Staff records were reviewed and contain current pediatric CPR/First Aid (EMSA) as well as current Mandated Reporter certificates. Assistant Director was reminded to keep training certifications current and renew certifications prior to expirations. LPA informed Assistant Director to provided current information with regard to the CCC's Licensee and Director. Assistant Director informed LPA no firearms or ammunition is stored on site.

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

Facility representative were 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
(CONT 809-C)
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2022
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: ARROYO GRANDE MONTESSORI SCHOOL
FACILITY NUMBER: 401710931
VISIT DATE: 08/05/2022
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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.

Type A deficiency is being cited based on LPA’s observation and record reviews pursuant to Title 22 of the CA Code of Regulations (refer to LIC 809-D). Licensee was provided a copy of their appeal rights.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Facility representative Elizabeth Silva.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 08/05/2022 02:33 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117


FACILITY NAME: ARROYO GRANDE MONTESSORI SCHOOL
FACILITY NUMBER: 401710931

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101238(g)
Buildings and Grounds
(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observing a kitchen knife stored and located in a unsecure low drawer accessible to children in care, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/08/2022
Plan of Correction
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CCC to tp provided CCLD a Plan of correction in writing by 8/8/22, concerning children accessing dangerous items on site and prevent such.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:
DATE: 08/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/05/2022
LIC809 (FAS) - (06/04)
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