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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197492786
Report Date: 03/10/2025
Date Signed: 03/10/2025 04:12:44 PM

Document Has Been Signed on 03/10/2025 04:12 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:MONTESSORI OF SANTA CLARITAFACILITY NUMBER:
197492786
ADMINISTRATOR/
DIRECTOR:		BRANDY BLACK-PEREAFACILITY TYPE:
830
ADDRESS:27757 BOUQUET CANYON ROADTELEPHONE:
(661) 296-0175
CITY:SANTA CLARITASTATE: CAZIP CODE:
91350
CAPACITY: 27TOTAL ENROLLED CHILDREN: 127CENSUS: 15DATE:
03/10/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:27 PM
MET WITH:Brandy Black-Perea, DirectorTIME VISIT/
INSPECTION COMPLETED:
04:20 PM
NARRATIVE
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On Monday, March 10, 2025, Licensing Program Analyst (LPA) Mayra Rivera conducted a Case Management Incident inspection to follow up on a self-reported incident that occurred on February 20, 2025. LPA met with director Brandy Black-Perea who guided LPA Rivera on a tour of the facility.

LPA entered the infant classroom and observed 10 infants with 3 staff present providing care and supervision. LPA entered the toddlers classroom and observed 5 toddlers present with 2 staff present providing care and supervision.

LPA observed the playground area and observed the black top area to be utilized for bikes and trikes. LPA observed the incident report dated 2/20/25 and treatment provided by facility by cleaning the wound, applied ice, tender love and care, and called mom to notify and asked parent to come to check the child. LPA observed the child to have a 1/2 inch scab. LPA observed doctor's note dated 2/20/25 stating return to school with no restrictions on 2/21/25.

During this visit, LPA Rivera interviewed the staff who witness the incident. Based on the interview, the child was running towards the black top area and tripped within own feet. Child was wearing flat velcro strap shoes.

This incident was an accident and no Title 22 violations.

A notice of site visit was given and must remain posted for 30 days. Failure to maintain posting as required will result in a $100.00 civil penalty. Exit interview conducted and report was reviewed with director Brandy Black-Perea.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2025
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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