198014608-8-1-2025-54-CC-RDEO-DK5TN8-20250801145219

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198014608
Report Date: 08/01/2025
Date Signed: 08/01/2025 02:52:32 PM

Document Has Been Signed on 08/01/2025 02:52 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 CHILDREN'S HOUSE - WEST		FACILITY NUMBER:	198014608
ADMINISTRATOR/ DIRECTOR:	MALKI MOONESINGHE		FACILITY TYPE:	850
ADDRESS:	5454 ATHERTON STREET		TELEPHONE:	(562) 494-3777
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90815
CAPACITY: 87	TOTAL ENROLLED CHILDREN: 53	CENSUS: 40	DATE:	08/01/2025
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:15 PM
MET WITH:	Assitant Director - Ana Chavez		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) Randy Derraco conducted an unannounced annual inspection on08/01/25 at 12:15 pm. LPA met with Ana Chavez, Assistant Director, who guided analyst on a tour of the facility. This is a preschool program which consists of 4 classrooms. Facility operation hours are Monday to Friday from 7:00 AM to 6:00 PM. All areas identified on this report were inspected. Upon arrival, the following staff were present during this inspection: Classroom 3: Staff S2 and S6 with 10 children; Classroom 4: Staff S4 with 5 children; Classroom 1: Staff S5 and S7 with 14 children; Classroom 2: Staff S1 and S3 with 11 children. Teacher-child ratios were observed to be in accordance with Title 22 Regulations. All children were observed to be under visual supervision of a teacher at all times. The following was observed during the tour of the facility: Children's roster was reviewed and is current. Sign in and out sheets were reviewed to ensure that the person who signs the child in and out uses their full legal signature and records the time of the day. Children present were signed in. Disaster drill log was available, last drill was conducted on 04/24/25. LPA observed required licensing documents posted on bulletin board on a wall next to the sign in sheets Furniture and equipment were inspected for age appropriateness and good repair. LPA observed material and equipment are free of sharp, loose, or pointed parts. Telephone service, heating, lighting and ventilation were evaluated and are operable. Children have their own basket to store their belongings. Linens are taken home each week on Friday to be washed and returned the following Monday. Extra linens

NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Randy Derraco
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2025

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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Document Has Been Signed on 08/01/2025 02:52 PM - It Cannot Be Edited

Created By: Randy Derraco On 08/01/2025 at 02:26 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 CHILDREN'S HOUSE - WEST	FACILITY NUMBER: 198014608
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/01/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101238(g)(1)

Buildings and Grounds

(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. (1) Storage areas for poisons shall be locked. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the center did not lock storage area for ant spray which poses and potential Health, safety and/or personal rights risk to persons in care.
	POC Due Date: 08/11/2025
	Plan of Correction
1 2 3 4	POC visit

Type B

Section Cited

CCR

101227(a)(6)

Food Service

(6) Menus shall be in writing and shall be posted at least one week in advance in an area accessible for review by the child's authorized representative. Copies of the menus as served shall be dated and kept on file for at least 30 days. Menus shall be made available for review by the child's authorized representative and the Department upon request. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the center did not make menu available for review by child's authorized representative which poses a potential Health, safety and/or personal rights risk to persons in care.
	POC Due Date: 08/11/2025
	Plan of Correction
1 2 3 4	POC Visit

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Denise Gibbs
NAME OF LICENSING PROGRAM MANAGER:

	Randy Derraco
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2025

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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MONTESSORI CHILDREN'S HOUSE - WEST	FACILITY NUMBER: 198014608
	VISIT DATE: 08/01/2025

NARRATIVE

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are kept in each classroom in case a child forgets to bring them back. Napping equipment (cots) were observed in separate storage areas. Per Director, the isolation area is located in the office. Age appropriate sinks and toilets were inspected for availability and good repair in all restrooms. General sanitation was observed.

Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. According to the Director, medication is only administered to a child when accompanied with a doctor's note. Medication is stored in the child's classroom in a cabinet where it is inaccessible to children in care. No child currently in care has medication that is stored. LPA observed cleaning supplies and ant spray kept in an unlocked cabinet above the sink between classrooms 1 and 2. LPA advised Director that a citation under California Code of Regulation (CCR) section 101238(g)(1) will be issued. LPA reminded Director that poisons stored at the facility must be locked, not just made inaccessible. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. First Aid supplies were observed in the classroom.

A menu was reviewed to ensure that they are being posted at least one week in advance and visible to an authorized representative. LPA observed 1 menu kept in the Director's office written on a dry erase calendar. LPA advised Director that a citation under CCR Section 101227(a)(6) will be issued. Per menu, the center offers a morning snack and an afternoon snack. Snacks are stored in a cabinet in the Director's office. Lunch is brought from each child's respective home. Lunch containers are individually labelled and properly stored or refrigerated. LPA observed that water is readily available indoors via water cups that are brought from home. If needed, teachers re-fill water cups using the fountain designated for each classroom.

Outdoor play equipment was observed to be in good condition, free of sharp, loose or pointed parts. Outdoor activity space surface is maintained in a safe condition and is free of hazards. Areas around and/or under climbing equipment, swings and slides have cushioning material to absorb a fall. The outdoor area had adequate shade. LPA observed that water is readily available outdoors via water cups that are brought from the classroom to the outdoor play area. If a re-fill is needed, teachers take a group of children with their cups from the outdoor play yard to the water fountain. The Director states that there are no bodies of water on the premises and LPA did not observe any bodies of water during this visit. Director states there are no weapons or firearms on the premises.

NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Randy Derraco
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2025

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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MONTESSORI CHILDREN'S HOUSE - WEST	FACILITY NUMBER: 198014608
	VISIT DATE: 08/01/2025

NARRATIVE

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All individuals present have obtained a criminal record clearance or criminal record exemption. There is at least one person trained in CPR and Pediatric First Aid present during this inspection. Children’s and Staff’s Records were reviewed and are complete.

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 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

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.

LPA advised the Director to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccdss.ca.gov

The following deficiencies listed on the attached deficiencies page LIC809D are being cited in accordance with California Code of Regulations Title 22.

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

Exit interview conducted and report was reviewed with Assistant Director, Ana Chavez.

NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Randy Derraco
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2025

LIC809 (FAS) - (06/04)

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