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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011974
Report Date: 12/17/2024
Date Signed: 12/17/2024 02:23:07 PM

Document Has Been Signed on 12/17/2024 02:23 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:MONTESSORI ON ELM PRESCHOOL + KINDERGARTENFACILITY NUMBER:
198011974
ADMINISTRATOR/
DIRECTOR:		WIJEYEWICKREMA, CASSANDRAFACILITY TYPE:
830
ADDRESS:930 ELM AVENUETELEPHONE:
(562) 570-8080
CITY:LONG BEACHSTATE: CAZIP CODE:
90813
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 14DATE:
12/17/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Teacher Ms. VickiTIME VISIT/
INSPECTION COMPLETED:
12:29 PM
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Licensing Program Analyst (LPA) Jeanette Estrada conducted an unannounced annual inspection at the facility. LPA initially met with Staff 1 who guided LPA on a tour of the facility. Director Cassandra wijeyewickrema, joined at a later time. LPA observed four children and two staff in Room 1, six children and two staff in Room 2 and four children and one staff in Room 3. Facility operation hours are Monday to Friday from 7:00 AM to 5:00 PM. There is also a preschool program (license #198011975) on the premises.

The infant program is located adjacent to the center's pre-school program. The infant program has no shared areas. All areas accessible to children were inspected. Furniture and equipment were inspected for age appropriateness and good repair. The facility has sufficient napping equipment, feeding chairs, and changing tables. Cribs were observed to be free from loose articles and objects including blankets, pillows and no objects were observed to be hanging above or to the side of the cribs.

The facility has a separate napping area and the nap area was observed to have a half wall that allows for constant auditory and visual supervision. Telephone service, heating, lighting and ventilation were evaluated. Children have their own cubby to store their belongings. Linens are taken home each week to be washed. Each classroom has a changing table within arms reach of a sink. Each classroom also has a restroom available. Age appropriate sinks and toilets were inspected for availability and good repair in all restrooms. General sanitation was observed. Availability of indoor drinking water was observed in classrooms. The facility tested for lead in drinking water on 3/4/23 with no lead exceedances found.

Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children and stored in latched cabinets. Carbon monoxide detectors were observed and are operable.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE: DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/17/2024
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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Document Has Been Signed on 12/17/2024 02:23 PM - It Cannot Be Edited


Created By: Jeanette Estrada On 12/17/2024 at 01:18 PM
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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MONTESSORI ON ELM PRESCHOOL + KINDERGARTEN
FACILITY NUMBER: 198011974

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/17/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in one staff who did not have a complete livescan clearance which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/18/2024
Plan of Correction
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Per Licensee, staff 4 will resubmit a livescan form LIC 9163 to have fingerprints properly completed. proof of completed livesca will be provided to LPA via email.
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above one staff did not have proof of required immunization to measles, pertussis or a TB clearance. which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/17/2025
Plan of Correction
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Per Director, Staff 4 will obtain proof of documents and will submit via email.
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:Karen Chambers
LICENSING EVALUATOR NAME:Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:
DATE: 12/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/17/2024


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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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MONTESSORI ON ELM PRESCHOOL + KINDERGARTEN
FACILITY NUMBER: 198011974
VISIT DATE: 12/17/2024
NARRATIVE
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Kitchen areas/food preparation areas and food storage areas are kept clean and are free of litter, rubbish, rodents, or any other vermin. All storage containers for solid waste, including moveable bins have tight-fitting covers that are kept on, and are in good repair. Trash cans used to discard food have tight fitting lids or solid waste bags are discarded immediately after each meal. LPA reminded Director that food and bottles that are brought from home need to be labeled with the children's name and properly refrigerator.

The outdoor playground was observed to be physically separate from the preschool component. Outdoor playground equipment is in a safe condition, 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. All areas around or under climbing equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard. Availability of outdoor drinking water was observed. LPA advised that no children shall be left without the supervision of a teacher at any time.

Children’s records were reviewed for Immunization Records, LIC 700- Identification and Emergency Information, LIC 702- Health History, LIC 701- Physicians Report, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, LIC 613A- Personal Rights, LIC 9227- Infant sleep form (0-12 months, and documentation of 15-minute Infant Sleep Check (0-24 months). Infants did not have form LIC 9227. LPA provided copy to Director. Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunization against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate. There is at least one person trained in CPR and Pediatric First Aid present during this inspection. Director was reminded all staff must complete mandated reporter every 2 years. Staff 4 does not have a completed livescan clearance or proof of required immunizations.

Facility Representative 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.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
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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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MONTESSORI ON ELM PRESCHOOL + KINDERGARTEN
FACILITY NUMBER: 198011974
VISIT DATE: 12/17/2024
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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.
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and
administrative records.
For IMS information see PIN 22-02-CCP. 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/.
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 at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.
Citations were issued today. See LIC 809D.
A notice of site visit was given to Facility Representative and must remain posted for 30 days.
Exit interview conducted and report was reviewed with Director Cassandra Wijeyewickrema.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
LIC809 (FAS) - (06/04)
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