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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191224296
Report Date: 10/20/2022
Date Signed: 10/20/2022 02:10:33 PM

Document Has Been Signed on 10/20/2022 02:10 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:PARK MONTESSORI CHILDREN'S CTR.FACILITY NUMBER:
191224296
ADMINISTRATOR:PARK, GRACEFACILITY TYPE:
850
ADDRESS:13130 HERRICK AVE.TELEPHONE:
(818) 367-5483
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY: 75TOTAL ENROLLED CHILDREN: 75CENSUS: 36DATE:
10/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Hannah Park TIME COMPLETED:
02:25 PM
NARRATIVE
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On 10/20/2022, Licensing Program Analyst (LPA) Justin Dorsey met with Director, Hannah Park for the purpose of conducting an unannounced Required - 1 year inspection. Upon arrival LPA Dorsey observed 36 children with 4 teachers in 3 classrooms.

LPA toured and inspected the the center. Furniture and equipment were inspected for age appropriateness and good repair. LPA observed a sufficient quantity of cots available for napping children. Bedding and linens were individually stored so that each child's bedding is identifiable, and no child's used bedding comes into contact with other bedding. The sheets and blankets are washed weekly (sent home with parents to wash or staff wash after hours) and cots are washed as needed.

The telephone service was verified. Heating, lighting, and ventilation are adequate. There are cubbies for children's belongings in each classroom. LPA observed age-appropriate toys and materials. Drinking water is available inside the classroom in the form of a water pitcher and reusable cups. There are fire alarms and a carbon monoxide detector located in the facility. Fire extinguishers in the center are maintained

The facility provides Lunch, per Director parents of the program provide the children with snacks. Menus are posted on the parents board at the entrance of the center. LPA observed an appropriate amount of food in the facility. Cleaning solutions are stored inaccessible in a hallway closet and under the sink in the kitchen. LPA Dorsey observed the cleaning supplies in the kitchen were stored separately from the children's food.

LPA inspected and observed clean bathrooms (toilets and sinks). The toilets and sinks are functioning properly and are age appropriate. LPA observed soap, toilet paper, and paper towels readily available. The water temperature is appropriate. The staff restroom located beside the Directors office.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE: DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 10/20/2022 02:10 PM - It Cannot Be Edited


Created By: Justin Dorsey On 10/20/2022 at 01:34 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
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: PARK MONTESSORI CHILDREN'S CTR.
FACILITY NUMBER: 191224296

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/20/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101170(d)
Criminal Record Clearance
(d) All individuals subject to criminal record review shall, be fingerprinted and sign a Criminal Record Statement (LIC 508 [Rev. 1/03]) under penalty of perjury.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and observation, the facility did not comply with the section cited above in which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/20/2022
Plan of Correction
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During the inspection the teacher was removed form the center. LPA advised Director to not allow the teacher to teach at the facility until they are fingerprint cleared.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Claretta Yates
LICENSING EVALUATOR NAME:Justin Dorsey
LICENSING EVALUATOR SIGNATURE:
DATE: 10/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/20/2022


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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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: PARK MONTESSORI CHILDREN'S CTR.
FACILITY NUMBER: 191224296
VISIT DATE: 10/20/2022
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LPA observed a fully stocked first aid kit. There is a updated Fire Drill/Earthquake, and a current Roster available.

The parent board was reviewed and has all the required forms posted. Children are inspected for illnesses as they arrive. Per Director there is only one child at the facility that takes medications. LPA Dorsey observed the medication was labeled and stored correctly. LPA Dorsey also observed parental authorization for the medication in the medication log. There are currently no children in care with IMS needs in this site. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

There is a separate area for isolation and care of ill children in the Directors office.



Sign-in and out sheets were reviewed. The facility uses a digital sign-in sheet. The Teacher to child ratio was observed and staff names were recorded.

Children and staff records were reviewed. LPA verified there is at least 1 staff person present with current CPR and First Aid Training (exp. 08/17/2023).

The outdoor play equipment was inspected for health, safety, cushioning material, good repair, and age appropriateness. The play area has sand for children to play. Per Director children's water bottles are brought outside during outdoor play. The play area was inspected and found to be free of hazards and inaccessibility to bodies of water.

During the visit LPA Dorsey observed Staff #1 in the Sunshine classroom with 12 children. LPA Dorsey found Staff #1 to not have a fingerprint clearance. Per Director Hannah the teacher was hired about a month ago and work 3 days a week for around 4 hours. LPA Dorsey cited the facility a Type A deficiency and a immediate $500 civil penalty was assessed. During the visit Staff #1 was removed from the facility, LPA Dorsey advised Director Hannah to not let the teacher teach in the facility until they are fingerprint
cleared.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
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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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: PARK MONTESSORI CHILDREN'S CTR.
FACILITY NUMBER: 191224296
VISIT DATE: 10/20/2022
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Director was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with Director Hannah 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 Director 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.

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.

LPA Dorsey informed Director Hannah that this report dated 10/20/22 shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Dorsey informed the Director Hannah to provide a copy of this licensing report 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.

Exit interview conducted and report was reviewed with the Director Hannah Park.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
LIC809 (FAS) - (06/04)
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