198011204-9-22-2023-33-CC-CTUA-CVUPSF-20230920113415

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198011204
Report Date: 09/20/2023
Date Signed: 09/22/2023 10:22:50 AM

Document Has Been Signed on 09/22/2023 10:22 AM - 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	INTERNATIONAL MONTESSORI PRESCHOOL		FACILITY NUMBER:	198011204
ADMINISTRATOR:	LAURIE SEGURA		FACILITY TYPE:	850
ADDRESS:	211 E. ARROW HWY		TELEPHONE:	(909) 399-9222
CITY:	CLAREMONT	STATE: CA	ZIP CODE:	91711
CAPACITY: 48	TOTAL ENROLLED CHILDREN: 26	CENSUS: 19	DATE:	09/20/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Yolanda Mena		TIME COMPLETED:	11:45 AM

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	On 9/20/2023 an unannounced Case Management-Incident inspection was conducted by Licensing Program Analyst (LPA) Carolyn Tuba who was following-up on an Unusual Incident Report. LPA met with Director, Yolanda Mena. Director guided LPA on a tour of the facility, which had a census of 19 children with 4 staff. The incident occurred on 09/12/2023 and was reported to the Department on 09/12/2023 via a written report emailed to Community Care Licensing Department. The facility reported the incident in a timely manner. The Unusual Incident stated that at 12 pm Child #1 (C1) had left the facility and got across the street from the facility and a good samaritan pulled over to assist. LPA interviewed Director and she disclosed that C1 was playing in the back playground and on that day, there were 22 children with 3 staff in care and 1 additional staff member was putting cots down in the nap room. The Director was assisting another child and noticed that C1 was not in the spot that they had been playing previously and noticed the back door that leads from the playground into the classroom was open. Director proceeded to go into the classroom and through the kitchen and found the door that parent’s access was open. Director went outside and found C1 across the street from the facility. (LPA took photos and measured from the front door to the spot that Director found C1 and measured that it was approximately 185' 9".) C1 was found unharmed. Director called C1’s parent to report the incident to them. Director stated she assumed that the front door where parents access might have been left open. According to Director, C1 was gone for about 2 minutes. Director stated that on the next day, 9/13/2023 a chime was installed and a self-closing mechanism on the front door that parents and children access to come into the facility. LPA and Director agreed that a chime on the door that leads out into the playground will also be installed. Extra staff is also being hired for supervision. Director and LPA have agreed that LPA will be referring facility to Technical Support Program (TSP), which is part of the Department of Social Services and LPA provided a brochure with information. Page 1 of 2

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: INTERNATIONAL MONTESSORI PRESCHOOL	FACILITY NUMBER: 198011204
	VISIT DATE: 09/20/2023

NARRATIVE

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The following deficiency listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiency that are being cited need to be cleared to protect the children’s health & safety.

One (1) Type A - A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Director currently has a copy of the parent Acknowledgement of Receipt of Licensing Reports Form..

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

Exit interview conducted and report was reviewed with the Director, Yolanda Mena.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 09/20/2023 11:34 AM - It Cannot Be Edited

Created By: Carolyn Tuba On 09/20/2023 at 11:05 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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: INTERNATIONAL MONTESSORI PRESCHOOL	FACILITY NUMBER: 198011204
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/20/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/27/2023 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections.......	1 2 3 4 5 6 7	Director stated that on the next day, 9/13/2023 a chime was installed and a self-closing mechanism on the front door that parents and children access to come into the facility. LPA and Director agreed to install a chime on the door that leads out into the playground. Extra staff is also being hired
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Based on Director interview, the child wandered away from the facility unsupervised for at least 2 minutes with no adult supervision. This poses an immediate Health and Safety risk to children in care.	8 9 10 11 12 13 14	for supervision. Director and LPA have agreed that LPA will be referring facility to Technical Support Program (TSP), which is part of the Department of Social Services. LPA will be conducting a follow-up visit.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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:

Ana Chico

LICENSING EVALUATOR NAME:

Carolyn Tuba

LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023

LIC809 (FAS) - (06/04)

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