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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157750003
Report Date: 05/01/2024
Date Signed: 05/22/2024 12:32:42 PM

Document Has Been Signed on 05/22/2024 12:32 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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:HERITAGE MONTESSORI SCHOOLFACILITY NUMBER:
157750003
ADMINISTRATOR/
DIRECTOR:		DENISE CAMPOSFACILITY TYPE:
850
ADDRESS:934 HERITAGE DRIVETELEPHONE:
(760) 446-7459
CITY:RIDGECRESTSTATE: CAZIP CODE:
93555
CAPACITY: 90TOTAL ENROLLED CHILDREN: 90CENSUS: 58DATE:
05/01/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Denise Campos, Director
Teresa White, Site Supervisor		TIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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This report is being amended to the report issued on 5/1/24.

On 5/1/24, Licensing Program Analyst (LPAs) Crystal Ali and Carol Heath met with Director Denise Campos to conduct an unannounced case management inspection. The purpose of the case management was to follow up on unusual incident report (UIR) received 3/25/24. LPA Ali took a census of the children. Upon arrival, LPAs observed 58 daycare children and 16 staff member present today.

Description of incident: Incident occurred on 3/25/24, child was napping and had a medical need will napping. The staff called the child mother first. Staff stayed with child and placed her on her side keeping close watch on her. The father of the child arrived first, then mother-in-law (grandma who is an EMT) with the child’s medication, and mother arrived. Father informed staff to call 911 when he arrived since the child was not responding to him. Mother-in-law gave the child her medication and the ambulance arrived approx. 1-2 minutes later. Ambulance transported child to nearest hospital. The hospital then transported the child by helicopter to another hospital where her doctor is stationed. The child was released from the hospital. Child was able to return to daycare by providing doctors note and ER medication to the facility. After two weeks, an administration decision was made to have the child removed from daycare until the parents could provide a nurse or paraprofessional to be with the child each day due to their medical condition. The child’s last day at daycare was 4/19/24.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Crystal Ali
LICENSING EVALUATOR SIGNATURE: DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/01/2024
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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: HERITAGE MONTESSORI SCHOOL
FACILITY NUMBER: 157750003
VISIT DATE: 05/01/2024
NARRATIVE
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3/28/24: LPA Ali arrived at facility and interview teacher Nancy Howell and obtain a facility roster.

5/1/24: During this inspection LPAs conducted interview with Teresa White and Denise Campos in individual private interviews. In addition, during the inspection, LPAs reviewed child file including medical documents.

The facility failed to comply with the Incidental Medical Services (IMS) plan that requires a facility, and all staff to know what type of IMS is provided and the trained staff are available to provide IMS when a child is in need of services.

Based on the information obtained, it is determined that the facility failed to comply with IMS regulation which resulted in day care staff not being fully prepared to care for a child that has certain medical needs. Therefore, the facility is being cited for Type B deficiency for the incident on 3/25/24.

A copy of this report along with appeal rights were provided to the facility representative. The notice of site visit was given and must remain posted for 30 days.

Exit interview conducted with Denise Campos, Director.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Crystal Ali
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2024
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Document Has Been Signed on 05/22/2024 12:34 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 05/22/2024 08:31 AM


Created By: Claretta Yates On 05/01/2024 at 12:44 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: HERITAGE MONTESSORI SCHOOL
FACILITY NUMBER: 157750003

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
06/21/2024
Section Cited
CCR
101173(c)

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101173(c) Plan of Operation: (c) The child care center shall operate in accordance with the terms specified in the plan of operation.

The requirement is not met as evidence by:
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The licensee shall submit a Plan of Operation to provide Incidential Medical Service by the due date.
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Based on interviews and record review, the licensee failed to have a Plan of Operation to provide Incidential Medical Services for child #1 which propose a potential health safety or personal rights risk to the person 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:Scott Herring
LICENSING EVALUATOR NAME:Claretta Yates
LICENSING EVALUATOR SIGNATURE:
DATE: 05/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/01/2024


LIC809 (FAS) - (06/04)
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