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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406208351
Report Date: 06/07/2021
Date Signed: 06/08/2021 03:56:35 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: 37DATE:
06/07/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:54 AM
MET WITH:Tamera DavisTIME COMPLETED:
03:05 PM
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On 6/7/2021 at 10:54am, Licensing Program Analyst (LPA) Melissa Stewart arrived at the center and conducted a Risk Assessment for COVID19 via telephone call with Director, Tamera Davis, prior to entering the facility. LPA met with Director and explained that the purpose of the visit was to conduct a Required Comprehensive inspection. Director reported that he operating hours of the center are 7:00am- 5:30pm, Monday- Friday. The center has a total capacity of 40 children ages 2 years- kindergarten which includes up to 12 Toddlers (age 18 months - 3 years). Director's school age child was sitting in the kitchen area at a table doing school work inside the preschool/kindergarten classroom supervised by one staff who was setting up the classroom for nap time while the remaining children were out doors. Director reported that her child (C1), who is home schooled and currently in third grade, is present at the center three (3) times per week and that (C1) does not interact with the other children at the center. Director accompanied LPA on a tour of the center. There were 28 children signed in by parents on the clipboard located in the preschool/kindergarten classroom. Each child's temperature was also documented on the sign in sheet.

At 11:00am, LPA reviewed the sign in sheet in the toddler classroom which is located in a separate building past the front door of the preschool building. At 11:02am, Director tested that carbon monoxide detector in the toddler room and it was found to be operational. LPA observed staff 1 (S1) and staff 2 (S2) supervising nine (9) toddlers. The toileting area was observed to be clean and no toxins were accessible to children. LPA observed that nap mats were approximately two (2) feet apart rather than the six (6) feet separation as indicated in the COVID19 industry guidance for child care programs. Director indicated that children lay down head to toe at nap time and directed staff 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: 06/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2021
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 6
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: 06/07/2021
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to re-arrange the nap mat placement beginning 6/8/2021 in order to comply with the industry guidance.

The toddlers were engaged in active play outdoors in the toddler yard which contains a wooden climbing structure with slide and one platform swing along with play house and child sized picnic tables. Director stated that children are permitted on the platform swing one at a time and that children do not push each other on the swing. LPA observed that water was readily available to children via water bottles or cups labeled with child's name. LPA observed that the cushioning material was not of sufficient depth under the swing. Director reported that the "green chip" material is raked at least twice a week in order to fill the areas where the material is displaced while children play. Director reported that this yard had not been raked this morning.

There were 28 preschool/kindergarten aged children outside supervised by three (3) staff. The preschool yard is separated from the toddler yard by a chain link fence with gate. LPA observed a rope swing hanging over the gate making it inaccessible to children. Director reported that the "Newtion Tree swing climbing rope" is made available to children at certain times during the day when staff are available to supervise its use (manufacturer age recommendation is 12 months and up). LPA observed that the "Legendary platform swing" which was being used when a child received an injury on 2/18/2021 had been removed.

LPA observed that all required forms, including COVID-19 information was posted inside the preschool classroom. The most recent fire drill was conducted on 5/24/21 at 10am. The center has a first aid kit and a locked medication box in the kitchen on top of the refrigerator. Director reported that there are no firearms, ammunition or bodies of water on the premises.

When LPA arrived, Director, staff and children were not wearing face coverings indoors. LPA discussed the current face covering mandate with Director who reported that she had spoken with Department of Public Health who had indicated that the "ZSHEILD" had been approved for use in school settings and that staff wear the "ZSHEILD" when indoors with children 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: 06/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2021
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: 06/07/2021
NARRATIVE
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and that the center has a supply of child sized face shields for use by children indoors. Director and staff were observed to wear face shields indoors after the current mandate was discussed.

LPA reviewed a sample of children and staff files. Of the files reviewed, the children's files were found to be complete. All staff's Pediatric CPR and First Aid certification expired in October 2020. Director stated that due to COVID19, she was unable to have all staff take the class together as usual. Neither of the staff (S1 and S2) providing care and supervision to toddler have course work relating to infant/toddler development.

Incidental Medical Services (IMS) policy was discussed. Director reported that that there are no children currently enrolled who require IMS. 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: www.ada.gov/childqanda.htm

Deficiencies cited based on LPA observation, interviews conducted and record review in accordance with the California Code of Regulations, Title 22, see LIC809D.

An exit interview was conducted and Plans of Corrections were reviewed and developed with Director. LPA reminded Director that it is her responsibility to ensure that the Child Care Center is in compliance with all Title 22, Div 12 regulations and California Department of Public Health COVID19 guidelines which can be accessed on-line at www.cdss.ca.gov. Due to a computer malfunction while signing the report, LPA could not print a copy of the report, appeal rights and Notice of Site Visit. Director agreed to received the documents via email and reply within 24 hours to confirm receipt of documents. LPA left the center at 3:05pm.

Upon receipt, Director shall 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).

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

DATE: 06/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2021
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: 06/07/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/07/2021
Section Cited

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(a)(1) In addition to other required training, at least one director or teacher at each day care center...shall have at least 15 hours of health and safety training, and if applicable, at least one additional hour of training pursuant to clause (ii) of subparagraph (C) of paragraph (2).
This requirement is not met as evidenced by:
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Based on record review and Director's statement, the Pediatric CPR and Fist Aid certification expired for all staff on 10/2020. Director failed to ensure that at least one staff on site had a current CPR/First Aid certification 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: 06/07/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2021
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: 06/07/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/07/2021
Section Cited

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1596.956 optional toddler program- (4) A ratio of six children to each teacher shall be maintained for all children in attendance at the toddler program. An aide who is participating in on-the-job training may be substituted for a teacher when directly supervised by a fully qualified teacher.
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Based on record review and Director's statement, neither S1 or S2 are fully qualified infant teachers. Director failed to ensure that staff supervising toddlers have completed a course in infant/toddler care which poses an immediate risk to the health and safety of children in care.
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Type A
06/07/2021
Section Cited

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(c) To be a fully qualified infant care teacher, a teacher shall have the following:
(1) Completion, with passing grades, of 12...units in early childhood or child development education...(A) At least three of the units required in (c)(1) above shall be related to the care of infants...
This requirement is not met as evidenced by:
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Based on record review and Director's statement, neither S1 or S2 has completed a course in infant/toddler care which poses a immediate 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: 06/07/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2021
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: 06/07/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
06/07/2021
Section Cited

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101161 Limitations on Capacity
(a) A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.
This requirement is not met as evidenced by:
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Based on Director's statement that C1 is a school age child (third grade), Director is operating the center beyond the limitation specified on the license which poses an immediate risk to the health and/or 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: 06/08/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/08/2021
LIC809 (FAS) - (06/04)
Page: 6 of 6