197494220-11-26-2024-58-CC-KSCT-DBDV6Z-20241126151024

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494220
Report Date: 11/26/2024
Date Signed: 11/26/2024 03:10:34 PM

Document Has Been Signed on 11/26/2024 03:10 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	MONTESSORI OF WEST ADAMS		FACILITY NUMBER:	197494220
ADMINISTRATOR/ DIRECTOR:	KHAN, RUHI		FACILITY TYPE:	850
ADDRESS:	4449 W. ADAMS BLVD		TELEPHONE:	(310) 215-3388
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90016
CAPACITY: 107	TOTAL ENROLLED CHILDREN: 107	CENSUS: 49	DATE:	11/26/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:50 AM
MET WITH:	Vanessa Verastegui- Director		TIME VISIT/ INSPECTION COMPLETED:	03:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA), Keyona Scott, conducted an unannounced 3 - Year Annual Required inspection to the child care center on 11/26/2024. LPA met with Office Manager (S1) at approximately 9:03 AM. LPA met with Director (S2), at approximately, 9:06 AM who guided LPA to conduct census of children in care. LPA observed 49 preschoolers engaged in morning activities and circle time with the appropriate teacher to child ratios. The classrooms are separated according to age group; the two (2) year old classroom (Knobbed Cylinders); three (3) year old classrooms (Number Rods and Color Tablets); four (4) and five (5) year old classrooms (Binomial Cube and Pink Tower). Per review of electronic roster printout, LPA observed multiple children arrived in care after LPA census conducted. The total census of children in care at the time of electronic printout was 64. All adults, working or volunteering at the facility have a criminal record clearance or exemption. LPA was guided on a tour of the facility by Director (S2). Physical Plant Facility operation hours are Monday through Friday 7:00 AM to 6:00 PM. LPA observed all areas identified on the facility sketch. The facility was kept clean, neat and orderly. LPA observed three (3) toilets and two (2) sinks, properly working, in restroom room 1 which is utilized by the three (3), four (4) and five (5) year old classrooms. LPA observed three (3) toilets and three (3) sinks, properly working, in restroom 2 that are utilized by the two (2) year old classroom. LPA also observed in restroom 2, storage cubbies labeled with child's name stored with diapers, wipes and other potty training essentials supplied by child's parent. The toilets and sinks in each restroom are safe and sanitary. All poisons and hazardous items are stored and inaccessible to children in care. All floors are clean and safe. Kitchen is used by staff only. LPA observed kitchen to be clean and free of litter, rubbish and rodents and/or any other vermin. Trash cans used to discard food have tight fitting lids. No food preparation is done at facility. Per Director (S2), lunch and snacks are provided by each child's parent. Each child's lunch and snack is stored in child's lunch bag and placed in each child's cubby. Each child brings own reusable water bottle daily. Child's water bottle is refilled with drinking water from Brita water filter system throughout the day as needed. Drinking water is readily available indoor and outdoor as needed. PAGE 1

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Keyona Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 11/26/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MONTESSORI OF WEST ADAMS	FACILITY NUMBER: 197494220
	VISIT DATE: 11/26/2024

NARRATIVE

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Outdoor playground equipment is in safe condition and is free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. LPA did not observe any high climbing equipment, slides or similar equipment. There are two play structures in which all areas around or under the play structures are cushioned with material that absorbs a fall. There is adequate shade in the play yard.

FACILITY RECORDS
There is at least one person present at facility that is trained in Pediatric CPR and First Aid. LPA also observed that staff have completed Mandated Reporter training. LPA advised Director to contact Regional Office to provide the name of the child care center director or fully qualified teacher(s) designated to act in the director's absence and also keep a copy on file at facility.

LPA observed parent board located in the main office of the facility with the following required postings:

Facility License
PUB 269 Child Passenger Restraint System Poster
PUB 393 Notification of Parents' Rights
LIC 610 Emergency Disaster Plan

LPA reviewed the following documents during inspection:

Verification of Disaster and Fire Drills
Daily Activity Schedule
Electronic Sign In/Out Sheets

LPA provided Director with the following form for review, completion, and filing:

LIC 9148 Earthquake Preparedness

LPA reviewed the following personnel records during today's inspection:

Staff Qualifications
Immunization Records for Measles, Pertussis (Tdap), Influenza (Flu)/Influenza waiver
Current Pediatric CPR/First Aid Certification

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SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Keyona Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 11/26/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MONTESSORI OF WEST ADAMS	FACILITY NUMBER: 197494220
	VISIT DATE: 11/26/2024

NARRATIVE

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LPA reviewed the following personnel records during today's inspection (continued):

TB clearance or risk assessment
LIC 503 Health Screening Report
LIC 508 Criminal Record Statement
LIC 9108 Statement Acknowledging Requirement to Report Child Abuse
Mandated Reporter Training Certificate
LIC 9052 Employee Rights

LPA reviewed the following children's records:

LIC 613A Personal Rights
Admission Agreement
LIC 700 Identification and Emergency Information
LIC 701 Physician's Report
LIC 995 Notification of Parents' Rights
LIC 627 Consent for Emergency Medical Treatment
Immunization Record

The following was thoroughly discussed:
Director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

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).
LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.
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SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Keyona Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 11/26/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024

LIC809 (FAS) - (06/04)

Page: 3 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 WEST ADAMS	FACILITY NUMBER: 197494220
	VISIT DATE: 11/26/2024

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) 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/.

Director 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.

The facility was operating in substantial compliance during today’s inspection on 11/26/2024. Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director (S2) and Academy Manager (S3).

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.

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SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Keyona Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 11/26/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024

LIC809 (FAS) - (06/04)

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