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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750219
Report Date: 08/28/2025
Date Signed: 08/28/2025 04:13:20 PM

Document Has Been Signed on 08/28/2025 04:13 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 BY THE LAKE, INCFACILITY NUMBER:
197750219
ADMINISTRATOR/
DIRECTOR:		ERIN JOHNSONFACILITY TYPE:
860
ADDRESS:28040 HASLEY CANYON ROADTELEPHONE:
(661) 607-2333
CITY:CASTAICSTATE: CAZIP CODE:
91384
CAPACITY: 184TOTAL ENROLLED CHILDREN: 184CENSUS: 0DATE:
08/28/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:21 AM
MET WITH:Erin Johnson, Regional Director, Rushani Thomas-Wise, Director, and Bishan Seneviratne, ApplicantTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analysts (LPA’s) Maddox and Calloway met with Erin Johnson, Regional Director, Rushani Thomas-Wise, Director, and Bishan Seneviratne, Applicant for the purpose of conducting an announced pre-licensing inspection. Applicant is requesting licensure of 36 Infants ages 0 – 24 months; 24 Toddlers ages 18 -36; and 124 preschool children ages 2 – 6 yrs. This center is located within a shopping center. During this inspection, LPA measured 9 classrooms. The days and hours of operation will be: Mon through Friday from 6:30 am – 6:30 pm.

INDOOR ACTIVITY SPACE:

· The child care center was toured and found to be clean, safe, sanitary, and in good repair to ensure the safety and well-being of children, employees and visitors


· Floors of all rooms have a surface that is safe and clean (---- flooring)
· A comfortable temperature for children shall always be maintained.
· Furniture and equipment are maintained in good condition, free of sharp, loose or pointed parts.
NAME OF LICENSING PROGRAM MANAGER: Deborah Lowe
NAME OF LICENSING PROGRAM ANALYST: Donna Maddox
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MONTESSORI BY THE LAKE, INC
FACILITY NUMBER: 197750219
VISIT DATE: 08/28/2025
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There are a variety of age-appropriate equipment, toys, and materials in good condition and in sufficient quantity to allow children present to fully participate in planned activities.
· Tables and chairs were present to meet the needs of the children.
· Drinking water: Children will bring water bottles, the center provides filtered water
· Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children were stored and inaccessible to children (Locked cabinet)
· There are fully stocked first-aid kit(s) in locations accessible to staff but inaccessible to children that include thermometers.
· The isolation area is located in the office for any child who becomes ill during the day.
· LPA observed operable carbon monoxide detectors, smoke detectors (hard wired), and fire extinguishers are located throughout the facility and fully charged.
· The center has a working telephone
· Sign-in and out procedure -- Brightwheel
· Staff shall conduct a wellness check to ensure that children with obvious symptoms of illness including, but not limited to, fever or vomiting, are not accepted.

NAPPING

· Mats used for napping were maintained in a safe condition.

NAME OF LICENSING PROGRAM MANAGER: Deborah Lowe
NAME OF LICENSING PROGRAM ANALYST: Donna Maddox
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MONTESSORI BY THE LAKE, INC
FACILITY NUMBER: 197750219
VISIT DATE: 08/28/2025
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·Each mat shall be equipped with a sheet to cover the mat and, depending on the weather, a sheet and/or blanket to cover the child.

· LPA informed Applicant mats should be wiped with a detergent/disinfectant weekly or when soiled or wet.

· Bedding shall be individually stored so that each child's bedding is identifiable, and no child's used bedding comes into contact with other bedding.

· Napping equipment shall be arranged so that each child has access to a walkway without having to walk on or over the cots or mats of other children

OUTDOOR

LPA observed shaded rest areas on each play yard (there are separate play yards for each component - Tarp). Children have safe access to the play yard which is enclosed by a fence to protect children and to keep them in the outdoor activity area. LPA’s did not observe any bodies of water present. The play yard was free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard. LPA’s observed rubber matting under climbing equipment (1 large slide set on the large yard and smaller slide set on the Toddler yard. The playgrounds are enclosed by a fence to protect children and to keep them in the outdoor activity area, fencing was at least four feet high. Play yard was under minor construction during this inspection).

Outside Drinking Water: Staff will bring out water pitchers (filtered water) and cups labeled with children’s names and their own personal water bottles

NAME OF LICENSING PROGRAM MANAGER: Deborah Lowe
NAME OF LICENSING PROGRAM ANALYST: Donna Maddox
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MONTESSORI BY THE LAKE, INC
FACILITY NUMBER: 197750219
VISIT DATE: 08/28/2025
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RESTROOMS

There are a total of 12 toilets and 14 sinks. LPA’s also observed changing tables next to hand washing sinks in the Infant and Toddler classrooms. All toilets and hand washing facilities were maintained. safe, and sanitary operating condition.

Staff bathroom- located in the main lobby and also will be the isolation bathroom

Measurements taken were as follows:


Room #A - Preschool
841/35 = 24
Room #B - PS
1025/35 = 29
Room #C - Toddler
777/35 = 22
Room #D - Infant
800/35 = 23
Room #E -
Crib Room
Room #F - Infant
442/35 = 13
Room #G - Preschool
858/35 = 25
Room #H - Preschool
480/35 = 14
NAME OF LICENSING PROGRAM MANAGER: Deborah Lowe
NAME OF LICENSING PROGRAM ANALYST: Donna Maddox
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MONTESSORI BY THE LAKE, INC
FACILITY NUMBER: 197750219
VISIT DATE: 08/28/2025
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Room #I - Preschool
1147/35 = 33
TOTAL INDOOR SPACE: 183

Bathroom:
There are a total of 12 Toilets and 12 sinks for a total of 180

Outside play space:
PS 2: 10554/75 = 141

PS 1: 3600

Toddler Yard: 4339/75 = 58

Infant: 3504/75 = 47

SUPERVISION:

Applicants shall ensure no child is left without the supervision of a teacher at any time, Supervision shall include visual observation.

INFANT NAPPING

·Sleeping infant(s) shall be directly observed by sight and sound at all times.


· (A) This shall include when the infants are going to sleep, are sleeping, or are in the process of waking up.
· (B) Staff shall physically check on sleeping infant(s) every 15 minutes and document the following:
· Labored breathing.
NAME OF LICENSING PROGRAM MANAGER: Deborah Lowe
NAME OF LICENSING PROGRAM ANALYST: Donna Maddox
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MONTESSORI BY THE LAKE, INC
FACILITY NUMBER: 197750219
VISIT DATE: 08/28/2025
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·Signs of distress, which includes but is not limited to flushed skin color, increase in body temperature and restlessness.

· Infants up to 12 months of age who are sleeping in a position other than on their back.

· 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.

· Cribs shall be free from all loose articles and objects, including blankets and pillows.

· Pacifiers shall be allowed in the crib if the following provisions are in place: There shall not be anything attached to the pacifier.

· Bumper pads shall not be used.

· LPA observed Cribs and cots arranged so as to provide a walkway and permit staff to reach each infant without having to step over or reach over any other infant.

· LPA explained the following regarding Section 101439.1 Infant Care Center Sleeping Equipment: Mattresses shall be firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the mattress so it cannot be dislodged.

· 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. Provided during inspection.

NAME OF LICENSING PROGRAM MANAGER: Deborah Lowe
NAME OF LICENSING PROGRAM ANALYST: Donna Maddox
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MONTESSORI BY THE LAKE, INC
FACILITY NUMBER: 197750219
VISIT DATE: 08/28/2025
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·Each crib, mat or cot shall be occupied by only one infant at a time.

· Bedding shall be changed daily

CHILDREN’S RECORDS:


LPA reviewed form LIC 311A with Applicant - Records to Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

TRANSPORTATION:

Center will not provide transportation.

FOOD SERVICES

Center will provide snacks only at this time

· Pesticides and other similar toxic substances were not stored in food storerooms, kitchen areas, food-preparation areas, or areas where kitchen equipment or utensils are stored.


· Soaps, detergents, cleaning compounds or similar substances were stored in areas separate from food supplies.
· Food preparation and storage areas shall be kept clean and free of litter and rubbish; and measures shall be taken to keep all such areas free of rodents and other vermin.
· Trashcans, including moveable bins, shall have a tight-fitting cover that is kept on; shall be in good repair; and shall be leakproof and rodent-proof.

· A refrigerator is available and shall be used to store any medication that requires refrigeration.

NAME OF LICENSING PROGRAM MANAGER: Deborah Lowe
NAME OF LICENSING PROGRAM ANALYST: Donna Maddox
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MONTESSORI BY THE LAKE, INC
FACILITY NUMBER: 197750219
VISIT DATE: 08/28/2025
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CRIMINAL RECORD REVIEW
Applicant, was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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.

CRIMINAL RECORD REVIEW
Applicant is aware of Guardian which is the Departments tool to verify fingerprint clearances.

HEALTH RELATED SERVICES:

Medications shall be kept in a safe place inaccessible to children. Applicant states staff will dispense prescription medications only.

Applicant has implemented a written plan to record the administration of prescription and nonprescription medications and to inform the child's authorized representative daily when such medications have been given.

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

NAME OF LICENSING PROGRAM MANAGER: Deborah Lowe
NAME OF LICENSING PROGRAM ANALYST: Donna Maddox
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MONTESSORI BY THE LAKE, INC
FACILITY NUMBER: 197750219
VISIT DATE: 08/28/2025
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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, available at: http://www.ada.gov/childqanda.htm - Center will provide IMS

LEAD TESTING

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).

POSTINGS:

LPA’s observed a Parent Board in the hallway the required forms that shall be posted after licensure including the telephone number of the local health department and information on child passenger restraint systems pursuant to Health and Safety Code section 1596.95(g) and Vehicle Code sections 27360 and 27360.5

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website

NAME OF LICENSING PROGRAM MANAGER: Deborah Lowe
NAME OF LICENSING PROGRAM ANALYST: Donna Maddox
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MONTESSORI BY THE LAKE, INC
FACILITY NUMBER: 197750219
VISIT DATE: 08/28/2025
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athttps://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication

Applicant is aware and reminded of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC 624B.



Each licensee shall have a disaster and mass casualty plan of action. The plan shall be in writing and shall be readily available.


Fire Clearance has been received for the requested capacity of 184 children, however with LPA’s measurements center can accommodate 183

Needed Prior to Licensure:

LPA will forward the NOIA letter, picture of diaper genie, picture of play yards once completed including shade.

An exit interview was conducted with the above items discussed and a copy of this report was read and provided to the Applicant, during this inspection. Final license determination will be made upon review of the Licensing Program Manager (LPM).

NAME OF LICENSING PROGRAM MANAGER: Deborah Lowe
NAME OF LICENSING PROGRAM ANALYST: Donna Maddox
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
LIC809 (FAS) - (06/04)
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