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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191500492
Report Date: 01/09/2023
Date Signed: 01/09/2023 12:59:16 PM

Document Has Been Signed on 01/09/2023 12:59 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:MONTESSORI HOUSE OF CHILDRENFACILITY NUMBER:
191500492
ADMINISTRATOR:DE VISSER, IRIS Y.FACILITY TYPE:
850
ADDRESS:18523 SOUTH ARLINE AVE.TELEPHONE:
(562) 924-3610
CITY:ARTESIASTATE: CAZIP CODE:
90701
CAPACITY: 80TOTAL ENROLLED CHILDREN: 42CENSUS: 40DATE:
01/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Assistant Director, Keesha Perera GloverTIME COMPLETED:
01:30 PM
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On January 9, 2023 at 9:30 am, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced inspection at the facility noted above and met with Assistant Director, Keesha Perera Glover. The purpose of the inspection was to conduct the Required 1 Year inspection at the facility. Entrance Checklist – Child Care Centers (LIC 125) was provided to the Assistant Director upon arrival. The facility is located on the premises of Artesia Cerritos United Methodist Church. Per Assistant Director, the program operates Monday through Friday from 7:30 am to 5:30 pm.

The Assistant Director guided LPA on a tour of the inside and outside of the facility. All areas on the facility sketch were inspected. The facility currently utilizes 3 classrooms; Room 1, Room 2, and Room 3. Room 2 and Room 3 is divided by a partition. Upon arrival, the following staff were present: Staff (S1) and S2 inside Room 1 with 21 preschool children, Director, Beverly Perera inside Room 2 with 10 preschool children, and S3 inside Room 3 with 9 preschool children.

The following documents are posted in a prominent, publicly accessible area: Facility License, Snack Menu, Child Passenger Restraint System Poster (PUB 269), Notification of Parents' Rights (LIC 393), Emergency Disaster Plan (LIC 610), and Personal Rights (LIC 613A). The facility did not have a Daily Activity Schedule available for review.

Children's roster was reviewed and is current. Sign-in and sign-out is conducted on a tablet using the Brightwheel application; all children present were signed in. Per Assistant Director, transportation is not provided by the program. Per Assistant Director, bedding is taken home on a weekly basis to be washed. According to the Assistant Director, medication is only administered to a child when accompanied with a doctor's note and medication is stored in a cabinet located in the office area.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MONTESSORI HOUSE OF CHILDREN
FACILITY NUMBER: 191500492
VISIT DATE: 01/09/2023
NARRATIVE
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Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. LPA observed napping equipment (cots) and cubbies inside each classroom. Per Assistant Director, the isolation area is in the office area. In the office area, a cot can be placed on the floor for an ill child and a children's restroom only used for isolation purposes is readily available if an ill child requires it. Age appropriate sinks and toilets were inspected for availability and good repair. General sanitation was observed. Availability of indoor and outdoor drinking water was observed (water bottles).

Carbon monoxide detector and smoke detector were tested and are operable. The fire extinguishers are fully charged and were last serviced on March 17, 2022. LPA observed electrical outlet covers installed in all child care areas. First Aid supplies were observed and kept inside the kitchen. The facility did not have verification of disaster and fire drills available for review.

Disinfectants, cleaning solutions, and other items that are hazardous to children, were made inaccessible to children in all areas. Assistant Director confirmed that there are no poisons stored at the facility. All kitchen, food preparation and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. All storage containers for solid waste have tight-fitting covers that are kept on and in good repair. Snacks were reviewed for availability, quantity and appropriateness to children in care.

Outdoor playground equipment is in a safe condition, free of sharp, lose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All areas around or under high climbing equipment, slides, and similar equipment are cushioned with material that could absorb a fall. LPA observed adequate shade in the outdoor play yard. Play area was also inspected for inaccessibility to bodies of water.

All individuals present have obtained a criminal record clearance or criminal record exemption. Assistant 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.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2023
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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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MONTESSORI HOUSE OF CHILDREN
FACILITY NUMBER: 191500492
VISIT DATE: 01/09/2023
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LPA conducted a review of 5 children’s records and 5 personnel records for completeness. Based on the record reviews, all children's records have the required documents per licensing regulations. The facility did not have the immunization record for measles available for all staff present. The facility did not have the immunization record for pertussis for Staff (S2) available for review. LPA found that Assistant Director, Keesha Perera Glover, S1, and S3 did not have a Health Screening Report (LIC 503) available for review. LPA also found that Director, Beverly Perera did not have the Preventative Health and Safety Practices (EMSA-approved) certificate of completion available for review. During the inspection, all staff present had a valid Pediatric First Aid and CPR certification. The names of children and staff whose records were reviewed were documented.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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 publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

LPA advised the Assistant Director on how to access forms, regulations, quarterly updates, and Provider Information Notices (PINs) on the Department website at: www.ccld.ca.gov.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Deficiencies were cited during today's inspection (refer to deficiency pages). A Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days.

Exit interview was conducted and report was reviewed with Assistant Director, Keesha Perera Glover.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/09/2023 12:59 PM - It Cannot Be Edited


Created By: Monique Ayala On 01/09/2023 at 12:24 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MONTESSORI HOUSE OF CHILDREN
FACILITY NUMBER: 191500492

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101174(d)
Disaster and Mass Casualty Plan
(d) Disaster drills shall be conducted at least every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, the licensee did not comply with the section cited above as the Assistant Director, Keesha Perera Glover confirmed that the facility did not have verification of disaster and/or fire drills available for review which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/09/2023
Plan of Correction
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The facility will conduct a fire and disaster drill at the facility and the Assistant Director will submit to LPA via e-mail verification of the drills by February 9th, including the date and time that each drill was conducted.
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as all staff present did not have the immunization record for measles available for review, and Staff (S2) did not have the immunization record for pertussis available for review which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/09/2023
Plan of Correction
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Assistant Director will submit the immunization records or documentation of exemption for staff to LPA via e-mail by February 9th.
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:Valarie Cook
LICENSING EVALUATOR NAME:Monique Ayala
LICENSING EVALUATOR SIGNATURE:
DATE: 01/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2023


LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 01/09/2023 12:59 PM - It Cannot Be Edited


Created By: Monique Ayala On 01/09/2023 at 12:24 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MONTESSORI HOUSE OF CHILDREN
FACILITY NUMBER: 191500492

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101215.1(m)
Child Care Center Director Qualifications and Duties
(m) A child care center director shall complete 16 hours of health and safety training if necessary pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as the Director, Beverly Perera did not have the Preventative Health and Safety Practices (EMSA-approved) certificate of completion available for review which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/09/2023
Plan of Correction
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The Director will complete the required training and submit proof of completion to LPA via e-mail by February 9th.
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 3 out of 5 personnel records (Assistant Director, S1, and S3) did not have a Health Screening Report (LIC 503) available for review which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/09/2023
Plan of Correction
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Assistant Director will submit the completed Health Screeening Report (LIC 503) for staff to LPA via e-mail by February 9th.
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:Valarie Cook
LICENSING EVALUATOR NAME:Monique Ayala
LICENSING EVALUATOR SIGNATURE:
DATE: 01/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2023


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