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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016502
Report Date: 12/10/2024
Date Signed: 12/10/2024 05:46:18 PM

Document Has Been Signed on 12/10/2024 05:46 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:BEYOND THE CLASSROOM, INC.FACILITY NUMBER:
198016502
ADMINISTRATOR/
DIRECTOR:		SAMANTHA MONTESFACILITY TYPE:
840
ADDRESS:304 PASADENA AVENUETELEPHONE:
(323) 449-4058
CITY:SOUTH PASADENASTATE: CAZIP CODE:
91030
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 10DATE:
12/10/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Samantha Montes, Director TIME VISIT/
INSPECTION COMPLETED:
06:00 PM
NARRATIVE
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On December 10, 2024, Licensing Program Analysts (LPAs) Monique Ayala and Joanne Solorio Campos conducted an unannounced Case Management inspection for the above facility. The purpose of the inspection is to follow up on an incident that occurred on 11/13/2024 and was reported to the department on 11/20/2024. The incident is a possible personal rights violation.

LPAs met with director, Samantha Montes who guided LPAs on a tour of the facility. LPAs observed 10 children with 4 staff members. Per director, there are additional arriving but are currently being picked up from school.

During the inspection, LPAs interviewed Staff #1 (S1) to Staff #3 (S3), interviewed Child #1 (C1) to Child #2 (C2), obtained a current child's facility roster and a copy of the director plan of correction (POC). Staff #4 (S4) was not present at the facility for interviews.

Based on interviews conducted, it was disclosed that S1 and S2 had a verbal altercation in front of children. Per C1 and C2, they saw S1 and S4 yelling at each other. Per S1-S3 and C1-C2, S1 and S4 were arguing about music. Per C1 and C2 they felt nervous, scared and surprised during the altercation. Per S2 she attempted to stop the altercation, but S1 and S4 were not listening and did not stop the altercation. Per S2 and S3, S3 was able to assist S1 in walking away from the incident. Per director, she spoke to both staff proper discipline was assessed.

The facility is being cited a Type B deficiency in accordance with Title 22 Regulations, see LIC809D.

An exit interview was conducted and a copy of this report was provided to director, Samantha Montes along with Appeal Rights. A Notice of Site Visit was provided and must be posted for 30 days.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE: DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2024
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 12/10/2024 05:46 PM - It Cannot Be Edited


Created By: Monique Jessica Ayala On 12/10/2024 at 03:46 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: BEYOND THE CLASSROOM, INC.
FACILITY NUMBER: 198016502

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/11/2024
Section Cited
CCR
102243(a)(2)

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Personal Rights: Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized... To receive safe, healthful and comfortable accommodations, furnishings...
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The director has already held an individual meeting with S1 and S4 and had them sign a copy to the addendum of the policy. The director provided LPAs with a copy of the addendum.
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This requirement was not met as evidence by: Based on interviews conducted it was disclosed by S1-S3 and C1-C2 that S1 and S4 were involved in a verbal altercation in front of children. This poses a potential health and safety risk to children in care.
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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 Chico
LICENSING EVALUATOR NAME:Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE:
DATE: 12/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/10/2024


LIC809 (FAS) - (06/04)
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