<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566214347
Report Date: 07/27/2023
Date Signed: 07/27/2023 05:03:31 PM


Document Has Been Signed on 07/27/2023 05:03 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:MONTESSORI OF THE VILLAGEFACILITY NUMBER:
566214347
ADMINISTRATOR:STEPHANIE CASE-FELIXSONFACILITY TYPE:
850
ADDRESS:30798 RUSSELL RANCH ROADTELEPHONE:
(818) 991-0720
CITY:WESTLAKE VILLAGESTATE: CAZIP CODE:
91362
CAPACITY:87CENSUS: 35DATE:
07/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Mayra GaetaTIME COMPLETED:
05:18 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
On July 27, 2023 at 11:45 AM, Licensing Program Analysts (LPA's) Susana Martinez and Rosie Breault conducted an unannounced Annual/Random inspection. LPA met with assistant director Mayra Gaeta and advised her the purpose of the inspection. Together with LPA's director provided a tour of the facility inside and outside. There were 35 children in the care of 7 adults at the time of the inspection.

LPA's observed sign-in/sign-out sheets did not correspond with the head count in each room. The room labeled Pink Tower is used for Toddlers. LPA's observed 6 children and 2 staff members (S1 and S2) present. Per review of the sign-in/sign-out sheet 7 children were signed in. LPA asked director why there was a discrepancy with the number of children. Director walked back into the Pink Tower room and asked S1 about C1. S1 stated C1 left about an hour ago. Director confirmed to LPA that C1 had left home about an hour ago. Staff (S1) and staff (S2) were not observed to be associated to the facility roster. Per review of online background clearance website (Guardian), S2's fingerprint clearance is "In Process".

LPA advised director that there was also a discrepancy with room used for 2 year old children labeled Trinominal Cube. At the time of inspection there were 9 children present with 1 staff (S3) who at the time of the inspection was not fingerprint cleared. LPA again advised director that number of children in the room does not correspond with the number of children currently signed in. LPA with director walked into the room and found C1. Director stated C1 was in the process of transitioning out of the Pink Tower room and into the Trinominal Cube room. LPA advised director of the seriousness of this situation. Director stated she was nervous.

LPA advised director that the head count in the Constructive Triangles room used for 4-5 year olds was also not corresponding with the number of children on the sign-in/sign-out sheet. Together with the director LPA walked into the room and completed a head count together. Director stated C2 was not signed in. LPA reminded director and teachers the importance of ensuring each child is signed in and signed out properly so that everyone is accounted for.
Continued on 809-C
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Susana MartinezTELEPHONE: 805-689-4212
LICENSING EVALUATOR SIGNATURE:
DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2023
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 7


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: MONTESSORI OF THE VILLAGE
FACILITY NUMBER: 566214347
VISIT DATE: 07/27/2023
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
26
27
28
29
30
31
32
In all classrooms, LPAs observed a variety of activities to service the needs of children. LPAs observed age appropriate toys, and equipment. Children nap on mats which are disinfected daily, and their individually bedding is stored separately. Facility provides filtered water and children bring their own water bottles. Facility provides morning and afternoons snack. LPAs observed kitchen to be clean, functioning, in working order. LPAs observed sufficient enough restrooms which at the time were in working order and clean.

The facility has two separate outdoor areas to prevent toddlers from commingling with the other children. Sufficient shade and play structures were observed with ample shading and various activities. LPA's observed a trash can with no tight fitting lid in the outdoor area. No bodies of water were present.

This facility provides Incidental Medical Services – IMS. LPA's reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. LPA's observed one child's (C3) medication to be missing the original packaging. A tampered label was placed on the inhaler. LPA's reminded director that all medication should be in its original packaging. LPA's also observed 3 other children's (C4, C5, and C6) to have expired medication in the storage box. LPA's reminded director that medication shall be checked regularly to verify that the medications are not expired.

For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

LPA observed required licensing documents mounted on the walls near the facility office. Last fire drill was conducted on 6/7/2023. Fire extinguisher was last serviced on 8/8/2022. LPA's observed trash cans to be missing tight fitting lids. LPA's also observed flies in the classrooms and bathrooms. LPA's reminded director that the center must be free of flies, other insects and rodents.

LPA discussed the safe sleep regulations with assistant director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [or facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Continued on 809-C
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Susana MartinezTELEPHONE: 805-689-4212
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023
LIC809 (FAS) - (06/04)
Page: 2 of 7
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: MONTESSORI OF THE VILLAGE
FACILITY NUMBER: 566214347
VISIT DATE: 07/27/2023
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
26
27
28
29
30
31
32
Director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPAs requested regulation 15 minute Sleep Logs as to which assistant director stated they were unaware they needed to be recorded and LPAs advised all napping infants to the age of two (2) must be observed and logged.

During the inspection, LPAs heard a child crying excessively during nap time. Child cried for a significant amount of time until LPA entered nap room and witness teacher laying sideways on top of child rubbing belly to get to sleep. LPA advised staff may not force a child to sleep/nap and stated must provide and alternate quiet activity. During the inspection owner Bishan Seneviratne arrived.

LPA's informed Director Mayra Gaeta that this report dated 7/27/2023 documents two (2) Type A citations which shall be posted for 30 consecutive days as there are immediate risks to the health, safety, or personal rights of children in care.

Also, LPA's informed the Director Mayra Gaeta to provide a copy of this licensing report dated 7/27/2023 that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Eight deficiencies were cited today. Two Type A and six Type B which can be viewed on the attached 809-D pages. LPAs visually observed not cleared staff exit the facility. LPAs advised assistant director, uncleared staff may not return until criminal record clearance has been obtained.

A civil penalty of $1500 was also cited during today's inspection due to having three staff members not associated to the facility.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted, appeal rights were given, and report was reviewed with director Mayra Gaeta and Bishan Senevirante.

SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Susana MartinezTELEPHONE: 805-689-4212
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023
LIC809 (FAS) - (06/04)
Page: 3 of 7
Document Has Been Signed on 07/27/2023 05:03 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: MONTESSORI OF THE VILLAGE
FACILITY NUMBER: 566214347

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101170(e)
Criminal Record Clearance
(e) 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:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and record review, the licensee did not comply with the section cited above in 3 out of 5 counts which poses an immediate health, safety or personal rights risk to persons in care. Criminal record clearance was not present for S1, S2 and S3.
POC Due Date: 07/27/2023
Plan of Correction
1
2
3
4
Unfingerprinted adults were observed to leave the premisis. Center is to submit a written statement on how they plan to prevent this in the future. The center will also be invited to attend an informal confrence at the Goleta Regional Office. The meeting will be scheduled at a later time.
Type A
Section Cited
CCR
101429(a)(2)(B)
Responsibility for Providing Care and Supervision for Infants
(B) Staff shall physically check on sleeping infant(s) every 15 minutes and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview and record review, the licensee did not comply with the section cited above in 6 out of 6 children which poses an immediate health, safety or personal rights risk to persons in care. Director stated the center does not conduct 15-minute checks for infants. LPA's provided safe-sleep FAQ's to the assistant director.
POC Due Date: 08/03/2023
Plan of Correction
1
2
3
4
Center is to submit proof of conducting and documenting 15-minute checks for infants in care. Center is to submit a written statement on how they plan to prevent this in the future. The center will also be invited to attend an informal confrence at the Goleta Regional Office. The meeting will be scheduled at a later time.
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: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Susana MartinezTELEPHONE: 805-689-4212
LICENSING EVALUATOR SIGNATURE:
DATE: 07/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2023
LIC809 (FAS) - (06/04)
Page: 4 of 7


Document Has Been Signed on 07/27/2023 05:03 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: MONTESSORI OF THE VILLAGE
FACILITY NUMBER: 566214347

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.954
Licensure Requirements
Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and interview the licensee did not comply with the section cited above in 4 out of 4 rooms which poses/posed a potential health, safety or personal rights risk to persons in care. The four rooms were observed to be missing a carbon monoxide detector.
POC Due Date: 08/10/2023
Plan of Correction
1
2
3
4
The center is to install a carbon monoxide detector in each room and provide the Department with proof of instalation. Center is to submit a written statement on how they plan to prevent this in the future. The center will also be invited to attend an informal confrence at the Goleta Regional Office. The meeting will be scheduled at a later time.
Type B
Section Cited
CCR
101226(e)(1)(B)
Health-Related Services
(e) In centers where the licensee chooses to handle medications: (1) All prescription and nonprescription medications shall be centrally stored in accordance with the requirements specified below: (B) Each container shall have an unaltered label.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, and record review, the licensee did not comply with the section cited above in 1 out of 1 medications which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/10/2023
Plan of Correction
1
2
3
4
The center is to obtain original medication packaging and submit proof to the Department. Center is to submit a written statement on how they plan to prevent this in the future. The center will also be invited to attend an informal confrence at the Goleta Regional Office. The meeting will be scheduled at a later time.
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: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Susana MartinezTELEPHONE: 805-689-4212
LICENSING EVALUATOR SIGNATURE:
DATE: 07/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2023
LIC809 (FAS) - (06/04)
Page: 5 of 7


Document Has Been Signed on 07/27/2023 05:03 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: MONTESSORI OF THE VILLAGE
FACILITY NUMBER: 566214347

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101239(f)(1)
Fixtures, Furniture, Equipment and Supplies
(f) Solid waste shall be stored, located and disposed of in a manner that will not transmit communicable diseases or odors, create a nuisance, or provide a breeding place or food source for insects or rodents. (1) All containers used for storage of solid wastes, including moveable bins, shall have a tightfitting cover that is kept on; shall be in good repair; and shall be leakproof and rodent-proof.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above in 5 out of 5 trash cans which poses/posed a potential health, safety or personal rights risk to persons in care. LPA's observed flies in the classrooms as well as the bathrooms.
POC Due Date: 08/10/2023
Plan of Correction
1
2
3
4
The center is to install tight fitted lids to trashcans and provide proof to the Department. Center is to submit a written statement on how they plan to prevent this in the future. The center will also be invited to attend an informal confrence at the Goleta Regional Office. The meeting will be scheduled at a later time.
Type B
Section Cited
CCR
101217(a)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and record review, the licensee did not comply with the section cited above in 5 out of 5 staff which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/10/2023
Plan of Correction
1
2
3
4
The center is to complete all employee files and provide proof to the Department. Center is to submit a written statement on how they plan to prevent this in the future. The center will also be invited to attend an informal confrence at the Goleta Regional Office. The meeting will be scheduled at a later time.
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: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Susana MartinezTELEPHONE: 805-689-4212
LICENSING EVALUATOR SIGNATURE:
DATE: 07/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2023
LIC809 (FAS) - (06/04)
Page: 6 of 7


Document Has Been Signed on 07/27/2023 05:03 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: MONTESSORI OF THE VILLAGE
FACILITY NUMBER: 566214347

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101229.1(b)
Sign In and Sign Out
(b) The person who brings the child to, and removes the child from, the center shall sign the child in/out.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview and record review, the licensee did not comply with the section cited above in 1 out of 1 children which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/10/2023
Plan of Correction
1
2
3
4
Center is to submit a written statement on how they plan to prevent this in the future. The center will also be invited to attend an informal confrence at the Goleta Regional Office. The meeting will be scheduled at a later time.
Type B
Section Cited
CCR
101430(a)(3)(B)
Infant Care Activities
(B) No infant shall be forced to sleep, to stay awake or to stay in the designated sleeping area.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and interview, the licensee did not comply with the section cited above in 1 out of 1 child which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/27/2023
Plan of Correction
1
2
3
4
This deficiency was cleared at the time of the visit as teacher provided an alternate activity for the child to engage in.
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: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Susana MartinezTELEPHONE: 805-689-4212
LICENSING EVALUATOR SIGNATURE:
DATE: 07/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2023
LIC809 (FAS) - (06/04)
Page: 7 of 7