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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016141
Report Date: 06/06/2024
Date Signed: 06/06/2024 10:12:00 AM


Document Has Been Signed on 06/06/2024 10:12 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:MONTESSORI SCHOOL OF HACIENDA HEIGHTSFACILITY NUMBER:
198016141
ADMINISTRATOR:ENOKA ATTALEFACILITY TYPE:
850
ADDRESS:15207 E. LOS ROBLES AVENUETELEPHONE:
(626) 968-0500
CITY:HACIENDA HEIGHTSSTATE: CAZIP CODE:
91745
CAPACITY:122CENSUS: 13DATE:
06/06/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Enoka Attale, DirectorTIME COMPLETED:
10:30 AM
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On 06/06/2024, Licensing Program Analyst (LPA) Kruz Long conducted an unannounced case management visit. A COVID-19 risk assessment was conducted prior to entering the facility. LPA met with Enoka Attale, Director and explained the purpose of the visit. There were 13 children with 2 staff members present in classroom #2.

The purpose of this visit is to follow up on an incident that occurred on 05/16/2024 which was reported to the department on 05/17/2024 (reported timely). The self-reported incident is regarding personal rights.

During the course of the investigation, LPAs Long and Ochoa toured classroom #2, interviewed Staff #1 (S1) and Staff #2 (S1) and attempted the interview Child #1 (C1).

On the day of the incident, C1’s finger was pinched when Staff closed the exit door of classroom #2. The injury required staff to contact 911 and medical attention was rendered. Interview with S2 indicate that the children in classroom #2 were lined up and getting ready to go outside. According to S2, Child #2 (C2) opened the door before the class was ready to exit. In efforts to stop the children from exiting, S2 closed the door without ensuring that it was safe to do so. C1 had their hand/fingers wedged between the door at which point their finger was pinched. S2 stated that they felt overwhelmed that day and did not notice C1 next to the door to prevent the incident from happening. Paramedics arrived and child’s finger required stiches. The finger was not broken or fractured.

Based on the facts of the incident, this incident could have been prevented. The deficiency was cited in accordance with the Title 22 of the California Code of Regulations and Health & Safety Codes. Please see 809D for documentation of deficiency.

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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Kruz LongTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MONTESSORI SCHOOL OF HACIENDA HEIGHTS
FACILITY NUMBER: 198016141
VISIT DATE: 06/06/2024
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Upon receipt of the licensing report. Licensee shall post report documenting Type A citation along with Notice of Site Visit Form in an area accessible for review for 30 days or a civil penalty of $100 will be assessed. Licensee shall also provide a copy of the report documenting Type A citation and any report resulting from a Non-Compliance Conference to all parents of currently enrolled children along with form LIC 9224 (Acknowledgement of Receipt of Licensing Report) for signature. Completed form shall be placed in child's file. Licensee shall also provide report and form to parents of newly enrolled children for the next 12 months.

An exit Interview was conducted, a copy of this report and appeal rights along with Notice of Site visit was provided to Enoka Attale, Director.

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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Kruz LongTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 06/06/2024 10:12 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: MONTESSORI SCHOOL OF HACIENDA HEIGHTS
FACILITY NUMBER: 198016141

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/14/2024
Section Cited
CCR
101223(a)(2)

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101223 Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement is not met as evidenced by:
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Per Director, additonal training was provided to Classroom #2 staff.
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Staff did not prevent Child's finger from getting wedged between the door at which point their finger was pinched requiring medical attendtion.
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POC cleared during visit. LPA obtained a copy of the signed training.

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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: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Kruz LongTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 06/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2024
LIC809 (FAS) - (06/04)
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