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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494880
Report Date: 08/10/2023
Date Signed: 08/10/2023 01:29:16 PM

Document Has Been Signed on 08/10/2023 01:29 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:VERMONT MONTESSORIFACILITY NUMBER:
197494880
ADMINISTRATOR:SILVIA FLORES RODRIGUEZFACILITY TYPE:
830
ADDRESS:8300 VERMONT AVENUETELEPHONE:
(323) 549-4570
CITY:LOS ANGELESSTATE: CAZIP CODE:
90044
CAPACITY: 26TOTAL ENROLLED CHILDREN: 17CENSUS: 13DATE:
08/10/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:27 AM
MET WITH:Sylvia Rodriguez, DirectorTIME COMPLETED:
12:40 PM
NARRATIVE
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During an investigation for a complaint Shandra Powell, Licensing Program Analyst (LPA), observed the following deficiency:

While LPA was touring the infant center, LPA observed 3 infants napping in cribs in the Caterpillar room with Staff #1. LPA observed Infant #1 napping on his stomach during inspection. LPA requested to review the infant's file. LPA did not observe a LIC9227 Individual Infant Sleeping Plan on file for infant. LPA discussed the Safe Sleep regulation with Staff #1 and Director during inspection. Infants up to 12 months of age who are sleeping in a position other than on their back and If the infant’s Individual Infant Sleeping Plan [LIC 9227 (3/20)] does not have Section C completed, staff shall return the infant to their back for sleeping.

Director and Staff #1 both stated the parent was given the form LIC9227 however has not returned the form. This is a potential health and and safety risk to children in care.

Type B deficiency was cited. See Facility Evaluation Report LIC 809D for deficiency cited.

A copy of this report was provided to the Director and an exit interview was conducted. This report, appeal rights and Notice of Site visit was given to Director Sylvia Rodriquez.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Shandra Powell
LICENSING EVALUATOR SIGNATURE: DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/10/2023
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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Document Has Been Signed on 08/10/2023 01:29 PM - It Cannot Be Edited


Created By: Shandra Powell On 08/10/2023 at 11:41 AM
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: VERMONT MONTESSORI
FACILITY NUMBER: 197494880

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/11/2023
Section Cited
CCR
101419.2

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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
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Director will have parent of each infant under the age of 12months complete the LIC9227 Individual Infant Sleeping Plan and place into child file. Director will email LPA a copy of form by POC date of 08/11/23.
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a completed Individual Infant Sleeping Plan [LIC 9227 (3/20)], which is incorporated by reference.
Licensee did not comply with the above regulation by file review. LPA did not observe a LIC9227 in infant file during inspection
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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:Karren Starks
LICENSING EVALUATOR NAME:Shandra Powell
LICENSING EVALUATOR SIGNATURE:
DATE: 08/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/10/2023


LIC809 (FAS) - (06/04)
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