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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016696
Report Date: 05/04/2023
Date Signed: 05/04/2023 01:45:52 PM

Document Has Been Signed on 05/04/2023 01:45 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:AMERICAN MONTESSORI PRESCHOOLFACILITY NUMBER:
198016696
ADMINISTRATOR:NOELINE SHANMUGANFACILITY TYPE:
830
ADDRESS:4817 EAGLE ROCK BLVD.TELEPHONE:
(323) 257-3709
CITY:LOS ANGELESSTATE: CAZIP CODE:
90041
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 10DATE:
05/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Assistant Director Blaha VlastaTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Veronica Martinez Garza arrived at the facility to conduct an unannounced Required – 1 year inspection on 05/04/23 at 09:00 am. A COVID-19 risk assessment was made prior to entry to the facility. LPA met with staff Eddiekyn Montemayor and stated the purpose of the visit. Per staff Helen Mangahis, Assistant Director Vlasta Blaha is stuck in traffic but is on the way to the facility. Assistant director arrived at approximately 10:10 am. This is an infant program licensed for 24 infants ages birth to 2 years of age. Per the Assistant Director, there are 10 infants enrolled. Facility hours of operation is from Monday to Friday, 7:00AM to 5:00PM. This facility has a preschool component (LIC #198020038). Facility has a staggered outdoor waiver posted on the parent board.

LPA took a tour of the facility. All areas identified on the Facility Sketch were inspected. The infant program is located next to the center's preschool program. There are two classrooms with an open connection. LPA observed in the first classroom: 5 infants with 1 staff and 5 infants with 1 staff in the second classroom. Teacher-infant ratios were observed to not be in compliance with Title 22 regulations; this is an immediate risk to the health and safety of children in care.

Furniture and equipment was inspected for age appropriateness, good repair, free of sharp, loose, or pointed parts. LPA observed that infant changing tables have a padded surface no less than one-inch-thick and are covered with paper and is disinfected after every use. The infant changing tables have raised sides that are at least 3 inches high. Toys were observed to be safe, and do not have sharp points, edges, splinters and are not made of small parts that can pose a choking hazard. LPA observed sufficient napping equipment that meets the requirements of Title 22 regulations, cribs are used for infants and cots are used for toddlers. LPA observed a blanket hanging on the side of the crib of child #4 (C4). Staff #2 (S2) immediately removed blanket.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE: DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/04/2023
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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Document Has Been Signed on 05/04/2023 01:45 PM - It Cannot Be Edited


Created By: Veronica Martinez-Garza On 05/04/2023 at 12:39 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: AMERICAN MONTESSORI PRESCHOOL
FACILITY NUMBER: 198016696

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/04/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101416.5(b)
Staff-Infant Ratio
(b) There shall be a ratio of one teacher for every four infants in attendance.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in S1 was caring for 5 infants and S2 was caring for 5 infants, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/12/2023
Plan of Correction
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Per Assistant Director, one of her staff was feeling ill today and called out. Assistant Director will have a meeting with staff to ensure there is communication when staff call out to ensure ratios are being met. Assistant Director will submit a copy of staff meeting to LPA by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:
DATE: 05/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/04/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/04/2023 01:45 PM - It Cannot Be Edited


Created By: Veronica Martinez-Garza On 05/04/2023 at 12:39 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: AMERICAN MONTESSORI PRESCHOOL
FACILITY NUMBER: 198016696

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/04/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101439.1(f)(3)
Infant Care Center Sleeping Equipment
(f) Cribs shall be free from all loose articles and objects, including blankets and pillows. (3) There shall be no objects hanging above or attached to the side of the crib.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in Crib for C4 had a blanket hanging on the side, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/04/2023
Plan of Correction
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S2 immediately removed blanket
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:
DATE: 05/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/04/2023


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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: AMERICAN MONTESSORI PRESCHOOL
FACILITY NUMBER: 198016696
VISIT DATE: 05/04/2023
NARRATIVE
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LPA also observed bibs hanging on the side of C5 crib,1 of the bibs had a pacifier clip holder. S2 immediately removed bibs and placed them inside C5 designated container. All indoor classrooms were inspected to ensure that the floors have a surface that is safe and clean. All toilets and hand washing facilities are in sanitary operating conditions. All materials and surfaces accessible to children are toxic free. At this time, the office is used as an isolation area.

Snack menus were reviewed to ensure that they are being posted at least one week in advance and visible to an authorized representative. Bottles, dishes, and/or containers of food brought by the infant's authorized representative are labeled with the infant's name. Parents of children enrolled bring in all food, milk, and formula items daily. Facility keeps extra snacks. There is drinking water available in all indoor classrooms and a water jug with disposable cups are taken outdoors. Facility keeps water bottles available. All storage containers for solid waste, including moveable bins, have tight fitting covers on and are in good repair. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are stored in an area inaccessible to infants. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. The licensee takes measures to keep the facility free of flies, other insects, and rodents.

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 as is free of hazards. Areas around and/or under climbing equipment cushioning material to absorb a fall. The Assistant Director states there are no bodies of water on the premises and LPA did not observe any bodies of water during this visit. Per Assistant Director, there are no weapons or firearms on the premises.

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. LPA observed C4 was not signed in (05/04/23). Staff Records were reviewed to ensure that a health screening report is on file. Infant Teachers files were reviewed to ensure that teachers present are qualified. Children’s Records were reviewed to ensure that Identification and Emergency form and a Needs and Services Plan are on file. Criminal Records Clearance for adults and verification of CPR/First Aid and health preventative practices documentation was reviewed.

SB792 Immunization Requirements for Staff and Employees was discussed. All staff have immunization documentation on file.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
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: AMERICAN MONTESSORI PRESCHOOL
FACILITY NUMBER: 198016696
VISIT DATE: 05/04/2023
NARRATIVE
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AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: http://mandatedreporterca.com/. All staff certificates are on file.

Incidental Medical Services (IMS) policy was discussed. Per Assistant Director, there are no infants on medication. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. LPA provided PIN 20-24-CCP and PUB 217 Never Shake a Baby Brochure. LPA provided consultation on LIC 9227.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/tion-process.

The following deficiencies were cited in accordance with Title 22 of the California Code of Regulations and Health & Safety Codes. Please see 809D for documentation of deficiencies.

LPA Veronica MartinezGarza informed Assistant Director Vlasta Blaha that this report dated 05/04/23 document(s) 1 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
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: AMERICAN MONTESSORI PRESCHOOL
FACILITY NUMBER: 198016696
VISIT DATE: 05/04/2023
NARRATIVE
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Also, LPA Veronica MartinezGarza informed the Assistant Director Vlasta Blaha to provide a copy of this licensing report dated 05/04/23 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview was conducted and report was reviewed with Assistant Director, Vlasta Blaha. Appeal Rights and Procedures explained and provided.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
LIC809 (FAS) - (06/04)
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