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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406208351
Report Date: 09/18/2019
Date Signed: 09/18/2019 05:19:48 PM

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:CHILDREN'S ACADEMY MONTESSORI SCHOOL, THEFACILITY NUMBER:
406208351
ADMINISTRATOR:TAMERA DAVISFACILITY TYPE:
850
ADDRESS:711 ROLLING HILLS DRIVETELEPHONE:
(805) 239-9790
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY:40CENSUS: 30DATE:
09/18/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Tamera Davis and Carly MarakTIME COMPLETED:
05:25 PM
NARRATIVE
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Licensing Program Analyst (LPA) Melissa Stewart conducted a case management inspection and met with Director, Tamera Davis. There were 25 preschool children supervised by three (3) staff. In the toddler room there were seven (7) toddlers sleeping supervised by two staff. Director stated that she would have to leave the facility at 2:30pm and advised that Carly Marak is designated as facility representative when she is not present. LPA explained the the purpose of the inspection was to follow up regarding an incident which was self reported by the Director to the Department on 8/29/19. Director reported that the parent of a child (C1) informed her that C1's diaper "was soaked" when parent picked the child up after naptime on 8/28/19. Director reviewed the diaper changing record and found that the staff had not been using the diaper recording chart for the past few months. Director reported that when questioned, the teachers reported that C1's diaper had been changed at 9:30am and 10:15am but could not recall if C1's diaper had been changed again before naptime at 12pm. The parent picked C1 up approximately five minutes after C1 had woken up from nap at 2:45pm. Teachers reported that C1's diaper had not been changed at 2:45pm prior to the parent picking up the child. Director admitted that C1's needs were not met on that day. Director has counselled staff regarding the diaper changing policy and the diaper record is now being kept daily. LPA reviewed the diaper record for the past three days and found it to be complete. Continued on 809-C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K StewartTELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2019
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: CHILDREN'S ACADEMY MONTESSORI SCHOOL, THE
FACILITY NUMBER: 406208351
VISIT DATE: 09/18/2019
NARRATIVE
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LPA reviewed the Licensing Program System (LIS) report and determined that substitute teacher Naomy Munoz did not have a Criminal Record Clearance. Ms. Marak informed LPA that Ms. Munoz had left the facility around 2:15pm to get her fingerprints done. Ms. Marak reported that Ms. Munoz has been present in the facility since August, but could not verify the exact number of days Ms. Munoz has worked since she was employed. Ms. Marak stated that Ms. Munoz worked at least six (6) days in the month of September.

Type A and type B deficiencies cited based on LPA observation, interviews conducted and record review in accordance with the California Code of Regulations, Title 22, Div 12 see LIC809D.

Upon receipt, provide copies of this licensing report to each parent/guardian of enrolled children and to parents/guardians of newly enrolled children during the next 12 months. Acknowledgement of Receipt LIC 9224 form shall be used for this purpose. LIC 9224 after completed shall be maintained in each child's file. (LIC 9224 was provided to Licensee).

A violation regarding criminal record clearance warrants an immediate civil penalty which was assessed in the amount of $500, see LIC421BG.

An exit interview was conducted and Plans of Corrections were reviewed and developed with facility representative. A copy of this report and appeal rights were discussed and left with facility representative, Carly Marak, whose signature on this form confirm receipt of these documents.

LPA observed Notice of Site Visit posted

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K StewartTELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2019
LIC809 (FAS) - (06/04)
Page: 2 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: CHILDREN'S ACADEMY MONTESSORI SCHOOL, THE
FACILITY NUMBER: 406208351
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/27/2019
Section Cited

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The licensee shall ensure that each child is accorded the following personal rights:
To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.

This requirement is not met as evidenced by:
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Based on LPA observation, interviews conducted, and record review, Licensee failed to ensure that C1s toileting needs were met on 8/28/19 which poses a potential risk to the health and safety of children in care.
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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: Melissa K StewartTELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:
DATE: 09/18/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2019
LIC809 (FAS) - (06/04)
Page: 3 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: CHILDREN'S ACADEMY MONTESSORI SCHOOL, THE
FACILITY NUMBER: 406208351
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/18/2019
Section Cited

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Criminal Record Clearance- All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:Obtain a California clearance or a criminal record exemption as required by the Department
This requirement is not met as evidenced by:
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Based on LPA observation, interviews conducted, and record review, Licensee failed to ensure that Naomy Munoz had a criminal record clearance prior to working in the facility which poses an immediate risk to the health and safety of children in care.
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This is an Amendment of the original document dated 9/18/19.
Type A
09/18/2019
Section Cited

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Violation of Section 101170(e) will result in an immediate assessment of civil penalties of one hundred dollars ($100) per violation per day for a maximum of five (5) days by the Department.

This requirement is not met as evidenced by:
Based on LPA observation, interviews conducted, and record review, Licensee failed
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to ensure that Naomy Munoz had a criminal record clearance prior to working in the facility which poses an immediate risk to the health and safety of children in care.
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This is an Amendment of the original document dated 9/18/19.
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: Melissa K StewartTELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:
DATE: 09/18/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4