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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573615117
Report Date: 06/06/2023
Date Signed: 06/06/2023 04:46:59 PM


Document Has Been Signed on 06/06/2023 04:46 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833



FACILITY NAME:PORTSIDE MONTESSORIFACILITY NUMBER:
573615117
ADMINISTRATOR:HERNANDEZ, M. SMITH, M.FACILITY TYPE:
850
ADDRESS:2700 LINDEN ROADTELEPHONE:
(916) 224-2033
CITY:WEST SACRAMENTOSTATE: CAZIP CODE:
95691
CAPACITY:84CENSUS: DATE:
06/06/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Rachel DelgadoTIME COMPLETED:
05:15 PM
NARRATIVE
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On 06/06/2023, Licensing Program Analysts (LPAs) Erwin Tjhia and Lauren Scott conducted a case management inspection to verify corrections of deficiencies cited on 05/30/2023. LPAs were greeted by the facility director, Rachel Delgado. There were 69 children, including 21 toddlers during today inspection.


LPA toured the facility and reviewed records. On 05/30/2023, facility was cited a Type A deficiency for staff were not associated to the facility. Today, LPAs observed one of the staff was at the facility and was not fingerprinted cleared. This deficiency cited on 05/30/2023 cannot be cleared today. Civil penalties were assessed for failure to correct this deficiency.

On 05/30/2023, the facility was also cited a Type A deficiency for staff that did not have any ECE courses.Today, LPA observed one fully qualified teacher in the classroom. This deficiency cited on 05/30/2023 can be cleared today.

Today during inspection, LPAs observed an additional individual, who does not have criminal record clearance, was present and caring for children during today's visit.

Title 22 Deficiencies have been cited on the attached LIC 809D. Upon receipt of Type A citations, facility shall post and provide copies of the LIC 809D for parents/guardians of children currently in care and for parents/guardians of newly enrolled children for the next 12 months. Facility must also keep the signed LIC 9224, Acknowledging Receipt of Licensing Reports LIC 809D in each child's files.



This report was reviewed and discussed with licensee. A notice of site visit and appeal rights were provided.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Erwin TjhiaTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2023
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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Document Has Been Signed on 06/06/2023 04:46 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833


FACILITY NAME: PORTSIDE MONTESSORI
FACILITY NUMBER: 573615117

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/07/2023
Section Cited
CCR
101170(e)

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(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:
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The staff will not return to the facility until they are fingerprinted cleared and associated to the facility.
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Based on record review, the licensee did not comply with the section cited above where one staff was not associated with the facility which poses an immediate health, safety or personal rights risk to persons 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: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Erwin TjhiaTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 06/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2023
LIC809 (FAS) - (06/04)
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