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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493004164
Report Date: 06/05/2019
Date Signed: 06/05/2019 12:25:14 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME:BENNETT VALLEY MONTESSORI - PRESCHOOLFACILITY NUMBER:
493004164
ADMINISTRATOR:HEXTRUM, JEANNINEFACILITY TYPE:
850
ADDRESS:2810 SUMMERFIELD ROADTELEPHONE:
(707) 537-8889
CITY:SANTA ROSASTATE: CAZIP CODE:
95405
CAPACITY:60CENSUS: 48DATE:
06/05/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:12 AM
MET WITH:Jeannine HextrumTIME COMPLETED:
12:40 PM
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An inspection was made to the facility by Licensing Program Analyst (LPA) J. Velasco in response to an Unusual Incident Report (UIR) received on 05/30/2019. Licensee and director Jeannine Hextrum (L1) reported that at 10:15 a.m. on 05/20/2019, 12 children were receiving supervision from two staff in the Prep classroom, when one child (C1, age 2) bit another child (C2, age 2) on their left shoulder, causing injury (red marks) but not breaking the skin. C2 had a pair of tongs that C1 wanted. Staff saw this and immediately intervened. L1 also reported that at 10:30 a.m. on 05/21/2019, 15 children were receiving supervision from three staff in the Prep classroom. C1 bit another child (C3, age 3) on the left shoulder, causing injury (red marks) but not breaking the skin. C3 had a ball that C1 wanted. Staff saw this and immediately intervened. In both cases staff washed the injured shoulders and applied ice. Parents of C1 were immediately notified after both incidents; C1's parents were required to pick up C1 immediately after the second incident. C2's and C3's parents were notified by staff at pickup. Neither C2 nor C3 required or received medical treatment.

This incident was reported to Community Care Licensing as required. Based on information available at this time, it does not appear that the incident resulted due to a lack of supervision or any other deficiency of Title 22 regulations. Staff immediately developed an action plan to prevent future incidents. L1 stated staff met with C1's parents and have been shadowing C1, who has not bitten any children since these incidents. Staff have also been monitoring interactions between children who both want the same toy and between children who are too close to each other. Staff watch for incidents that may trigger biting or other behaviors and work to ensure children have other strategies for conflict resolution.

Continued on LIC 809-C.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Jennifer VelascoTELEPHONE: (707) 588-5044
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2019
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME: BENNETT VALLEY MONTESSORI - PRESCHOOL
FACILITY NUMBER: 493004164
VISIT DATE: 06/05/2019
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Continued from LIC 809.

During today's inspection, staff were observed to provide adequate supervision and operate within ratio, with 48 children receiving supervision from seven staff.

This report was reviewed and discussed with L1. All licensing reports are public information and must be made available upon request.

No deficiencies were cited during this inspection.

Notice of Site Visit shall be posted for 30 days from today's visit.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Jennifer VelascoTELEPHONE: (707) 588-5044
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2019
LIC809 (FAS) - (06/04)
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