503603196-10-18-2019-04-CC-RGUZ-BH3LLJ-20191018085111

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 503603196
Report Date: 10/17/2019
Date Signed: 10/18/2019 08:51:17 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	MONTESSORI SCHOOL OF MODESTO		FACILITY NUMBER:	503603196
ADMINISTRATOR:	SEGURA, EVA		FACILITY TYPE:	850
ADDRESS:	3501 SAN CLEMENTE AVE.		TELEPHONE:	(209) 567-1115
CITY:	MODESTO	STATE: CA	ZIP CODE:	95356
CAPACITY:	140	CENSUS: 69	DATE:	10/17/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Eva Segura		TIME COMPLETED:	12:30 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	An unannounced annual inspection was conducted today by Licensing Program Analysts (LPAs) Robert Gutierrez & Diane Mercado. LPAs met with Director Eva Segura and toured the facility, both indoors and outdoors. There are no swimming pools or other bodies of water on the premises. Firearms and ammunition are not permitted on the premises. All children are under supervision, including visual supervision, of a teacher at all times. There is a ratio of one teacher supervising no more than 12 children in attendance. Disinfectants, cleaning solutions and other dangerous items are inaccessible to children. No poisons were observed during today’s inspection. All materials and surfaces accessible to children are toxic free. Medications are in a safe place inaccessible to children. All toilets, hand washing, and bathing facilities are in safe and sanitary operating conditions. All floors are clean and safe. Furniture and other equipment are in good condition, free of sharp, loose, or pointed parts. All kitchen, food prep, and storage areas are clean, free of litter, rubbish, and rodents/vermin. All food is protected from contamination, and contaminated food is discarded immediately. Solid waste storage vessels, including moveable bins, have tight-fitting covers on, are in good repair. Uncontaminated drinking water is available both indoors and outdoors. All foods/beverages capable of rapid spoiling are stored in covered containers at 45 (F) or less. Playground equipment is in good condition, free of sharp, loose, or pointed parts. Outdoor activity space surface is maintained in a safe condition and is free of hazards. Areas around high climbing equipment slides have cushioning material to absorb falls. Community Care Licensing (CCL) shall notify a licensee to immediately terminate the employment of, or to remove/bar any person with specified convictions or for other reasons. The licensee shall comply with the notice. Before working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have a clearance or exemption and have been associated to the facility. Staff records contain appropriate, documentation of education credits and Mandated reporter training. An emergency fire/disaster drill has been completed within the last 6 months. At least one person trained in CPR and Pediatric first-aid is present when children are at the facility or at off-site activities. Licensee has a current roster of the children. LPAs reviewed a sample of children’s file and observed files were complete. Licensee maintains admission agreement and forms as required. Required CCL forms such as facility license, personal rights, menus, child passenger restraint system poster, earthquake preparedness checklist, and parent’s right poster are posted on the parent board. This is a full day program that operates throughout the year. The hours of operation are 7:00am – 6:00pm, Monday through Friday. Continued on 809-C

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Robert Gutierrez	TELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019

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, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: MONTESSORI SCHOOL OF MODESTO	FACILITY NUMBER: 503603196
	VISIT DATE: 10/17/2019

NARRATIVE

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This facility provides Incidental Medical Services (IMS). LPAs reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. The following information regarding Americans with Disability Act (ADA) was provided: US Department of Justice toll free ADA Information line at (800) 514-0301(voice) and (800) 514-0383 (TDD) and website link
https://www.ada.gov/childqanda.htm for Commonly Asked Questions about Child Care Centers and the ADA.

LPAs and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINS), Quarterly Updates, Mandated Reporter Training, Lead Poisoning Facts, Forms and Regulations.

Per Chapter 1, Division 12, Title 22 of the California Code of Regulations no deficiencies are observed during today’s annual inspection. Site Visit Notice posted on the parent board. Exit interview was conducted with Director Eva Segura.

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Susie Fanning	TELEPHONE: (559) 650-7890
LICENSING EVALUATOR NAME: Robert Gutierrez	TELEPHONE: 559-243-4588
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019

LIC809 (FAS) - (06/04)

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