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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197417032
Report Date: 01/27/2025
Date Signed: 01/27/2025 02:50:21 PM

Document Has Been Signed on 01/27/2025 02:50 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:MONTESSORI OF CHATSWORTHFACILITY NUMBER:
197417032
ADMINISTRATOR/
DIRECTOR:		ERBE, ANNAFACILITY TYPE:
830
ADDRESS:10616 ANDORA AVENUETELEPHONE:
(818) 709-2980
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY: 16TOTAL ENROLLED CHILDREN: 16CENSUS: DATE:
01/27/2025
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Mary Noorzay, Assistant DirectorTIME VISIT/
INSPECTION COMPLETED:
03:05 PM
NARRATIVE
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On 01/27/2025 at 09:15 AM, Licensing Program Analyst (LPA) Elicia Calvillo conducted an unannounced Annual Required Inspection. Facility is located at 10616 Andora Avenue, Chatsworth, CA 91311. LPA identified self and met with Mary Noorzay, Assistant Director, LPA identified reason for visit and provided Entrance Checklist -Child Care Centers (LIC 125) to help facilitate the inspection.

Facility Representative (FR) Mary Noorzay, Assistant Director allowed entry to facility and provided LPA a guided tour of inside and outside of the facility. LPA observed 11 children and 4 staff. The facility is currently licensed for a capacity of 16, per FR they currently have 16 enrolled. The facility hours of operation are currently Monday thru Friday from 06:30 AM to 05:30 PM.

Required postings were observed posted in Main Lobby.

The facility is made up of 5 Preschool classrooms and 1 Infant classroom is used for the Infant facility. Infant Classroom #4, 6 weeks to 2 year-olds, with 4 staff.

Beginning at 09:45 AM, LPA observed the following in Infant Classroom #4. The furniture, toys, and equipment were inspected for age appropriateness and were in good repair. There were cubbies used for each child to store their belongings. Drinking water was readily available with individual bottles and pitchers of water are available in the classrooms to refill the individual bottles. The Infant Classroom Sleeping area was inspected and LPA observed that the cribs were arranged in a manner that did not allow a walkway and work space between the cribs was not sufficient to permit staff to reach infants without having to move cribs to the middle of the sleeping area (Photos Taken). LPA observed a changing table that was inspected for safety and sanitation and a sink within arms reach of the changing table.
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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE: DATE: 01/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/27/2025
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 01/27/2025 02:50 PM - It Cannot Be Edited


Created By: Elicia Calvillo On 01/27/2025 at 01:58 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MONTESSORI OF CHATSWORTH
FACILITY NUMBER: 197417032

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/27/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101439.1(g)
Infant Care Center Sleeping Equipment
(g) Cribs, mats or cots shall be arranged so as to provide a walkway and work space between the cribs, mats or cots sufficient to permit staff to reach each infant without having to step over or reach over any other infant.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in that there was not sufficient walking space between cribs for staff to walk or workspace for staff to reach for infants which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/27/2025
Plan of Correction
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Per Assistant Director, they will expand the crib area to include a walkway that is sufficient for staff to walk between cribs by the plan of correction due date 02/27/2024. Assistant Director will email LPA photos to show the expansin of the Infant Sleeping area by the POC due date.
Type B
Section Cited
CCR
101419.2(a)
Infant Needs and Services Plan
(a) Prior to the infant's first day at the center, the infant care center director or assistant director shall complete a needs and services plan for the infant.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in 3 of 5 childrens records did not contain an Infant Needs and Service Plan readily available upon request which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/27/2025
Plan of Correction
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Per Asssistant Director, a Infant Needs and Services Plan will be requested from the parents by the plan of correction due date 02/27/2024. Assistant Director will email LPA copies of the forms by the POC due date.
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:Rita Ramos
LICENSING EVALUATOR NAME:Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:
DATE: 01/27/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/27/2025


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Page: 2 of 6
Document Has Been Signed on 01/27/2025 02:50 PM - It Cannot Be Edited


Created By: Elicia Calvillo On 01/27/2025 at 01:58 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MONTESSORI OF CHATSWORTH
FACILITY NUMBER: 197417032

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/27/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101419.2(b)(2)
Infant Needs and Services Plan
(b) The needs and services plan shall be in writing and shall include the following: (2) Infants up to 12 months of age shall have a completed Individual Infant Sleeping Plan [LIC 9227 (3/20)], which is incorporated by reference.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in that 3 out 5 childrens files did not contain an Individueal Infant Sleeping Plan which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/27/2025
Plan of Correction
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Per Asssistant Director, a Infant Needs and Services Plan will be requested from the parents by the plan of correction due date 02/27/2024. Assistant Director will email LPA copies of the forms by the POC due date.
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:Rita Ramos
LICENSING EVALUATOR NAME:Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:
DATE: 01/27/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/27/2025


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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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MONTESSORI OF CHATSWORTH
FACILITY NUMBER: 197417032
VISIT DATE: 01/27/2025
NARRATIVE
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Per FP, there are no children potty training. LPA observed a refrigerator in the sleeping area that contained infant bottles that were labeled with each child’s name. There is telephone service, heating, lighting and ventilation were evaluated for safety and comfort.

LPA observed a first aid kits located in the classroom and inventoried for necessary supplies. LPA observed a device on the classroom ceilings in the classroom, per FR it is a carbon monoxide detector. LPA observed smoke detector via fire alarm. Disaster drill log was available, and the last disaster drill was conducted on 01/10/2025. Per FR, isolation area for sick children is in the office. Hazardous items including poisonous cleaning compounds were stored inaccessible to children. LPA observed cleaning solutions stored in the supply closet on a high shelf in the sleeping area.

Beginning at 10:05 AM, LPA did observe the kitchen area/ food preparation area, per FR children are bottled feed, parents will provide snack/lunch, or the parent may request a hot meal. LPA did not observe any open containers in the refrigerator. Food preparation was inspected for safety and sanitation, hazardous items including poisonous cleaning compounds were stored inaccessible to children with the use of door lock to the kitchen.

Beginning at 09:55 AM, LPA toured the outdoor play area and observed playground equipment in safe conditions, free of sharp, loose, or pointed parts, in good repair and age appropriate. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. Children have access to a slide in the play yard and there is rubber material under and around the slide to absorb falls. There is adequate shade in the play yard. The children have access individual bottles and a pitcher of water for refills during outdoor play. LPA advised that no children shall be left without the supervision at any time. There is no swimming pool or other bodies of water on the premises.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2025
LIC809 (FAS) - (06/04)
Page: 4 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MONTESSORI OF CHATSWORTH
FACILITY NUMBER: 197417032
VISIT DATE: 01/27/2025
NARRATIVE
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Beginning at 12:30 PM, staff and children’s records were reviewed for completeness. Inspection of required forms was made and documented on the LIC 857 for children and the LIC 859 for staff. There were 3 out 5 children’s records that did not contain Needs and Services Plan for Infants and LIC9227 Individual Infant Sleeping Plan. There were 3 out 5 staff records that did no contain complete Immunization Records. Criminal Record Clearances were reviewed for adults. CPR card expires on 06/2026 for Assistant Director. Inspection of required forms were discussed.

LPA observed that teacher-child ratios were maintained, and staff names were recorded. Care and supervision was evaluated to determine if the basic needs of children are met and appropriate. Sign-in and out sheets and procedures were reviewed. LPA observed 6 of 11 children signed in at time of inspection. Personal Rights of children were observed by LPA.

This facility provides Incidental Medical Services - IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children's, personnel, and administrative records. 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/.

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/.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP).

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2025
LIC809 (FAS) - (06/04)
Page: 5 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MONTESSORI OF CHATSWORTH
FACILITY NUMBER: 197417032
VISIT DATE: 01/27/2025
NARRATIVE
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LPA verified that the lead testing was completed in accordance with the Written Directives outlined in PIN 21-21.1-CCP.

Facility Representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, there are three Type B deficiencies being cited, 101439.1(g) Infant Care Center Sleeping Equipment, 101419.2(a) Infant Needs and Services Plan, and 101419.2(b)(2) Infant Needs and Services Plan and a plan of correction due date 02/00/2025

A Notice of Site Visit was given and must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to comply with posting requirement will result in an
immediate civil penalty of $100.00

Exit interview was conducted with Sabrina Betancourt, Assistant Director including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2025
LIC809 (FAS) - (06/04)
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