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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016696
Report Date: 02/22/2024
Date Signed: 02/22/2024 05:00:21 PM

Document Has Been Signed on 02/22/2024 05:00 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 CC RO, 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: 5DATE:
02/22/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Assistant director Vlasta BahaTIME COMPLETED:
05:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Veronica Martinez Garza arrived at the facility to conduct an unannounced Required – 3 year inspection on 02/22/24 at 11:15 am. Per staff Helinda Macasieb, Assistant Director Vlasta Blaha is on the way to the facility. Assistant director arrived at 12:10pm. This is an infant program licensed for 24 infants ages birth to 2 years of age. Per the assistant director, there are 5 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 0 infants with 0 staff in the second classroom. Per assistant director, the second classroom is not in use. Teacher-infant ratios were observed not to be in compliance with Title 22 regulations; this is an immediate risk to the health and safety of children in care. Per assistant director, the fully qualified teacher is on leave and the other aide called out. Assistant director also stated that she has been assisting in the infant room; however, she was running late today.

All indoor classrooms were inspected to ensure that the floors have a surface that is safe and clean. All materials and surfaces accessible to children are toxic free. According to the assistant director, infants are not potty trained and do not use the restroom. Infants wash their hands in the sink located in classroom 1. Currently, the office is used as an isolation area. Furniture and equipment were 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. Infants have their own cubby to store their belongings. Per assistant director, bedding is provided by the parents and is washed at the end of the week, or as needed.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 8
Document Has Been Signed on 02/22/2024 05:00 PM - It Cannot Be Edited


Created By: Veronica Martinez-Garza On 02/22/2024 at 02:52 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: 02/22/2024

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, the licensee did not comply with the section cited above in LPA observed staff 1 (S1) an aide was alone with 5 infants, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/23/2024
Plan of Correction
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Per assistant director, she spoke with the Licensee on 02/20/24 to request new hires. Per assistant director, she is usually present assisting in the infant room except for today. Per assistant director, she will ensure that she is present in the facility until they hire new staff. LPA advised assistant director to consider a staggered schedule for infants/staff or look into the services of Child Care Careers. Per Assistant director, she will submit a written plan 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: 02/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/22/2024


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Page: 2 of 8
Document Has Been Signed on 02/22/2024 05:00 PM - It Cannot Be Edited


Created By: Veronica Martinez-Garza On 02/22/2024 at 02:52 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: 02/22/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238(a)
Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

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 LPA observed holes on the wall, spider webs, loose light panel covers in the second classroom which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/22/2024
Plan of Correction
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Per assistant director, the second classroom will be cleaned to remove the spider webs, seal the wall holes, and secure the light panels. Proof will be submitted to LPA by POC due date.
Type B
Section Cited
CCR
101238.2(d)(2)
Outdoor Activity Space
(d) The surface of the outdoor activity space shall be maintained: (2) Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard.

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 LPA observed the wood fence is chipping and several equipment has spider webs which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/22/2024
Plan of Correction
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Per assistant director, she will speak with the Licensee to fix the wood fence and will remove the spider webs from the outdoor equipment. Assistant director will submit proof to LPA by POC due date.
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: 02/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/22/2024


LIC809 (FAS) - (06/04)
Page: 3 of 8
Document Has Been Signed on 02/22/2024 05:00 PM - It Cannot Be Edited


Created By: Veronica Martinez-Garza On 02/22/2024 at 02:52 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: 02/22/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101416.2(c)(1)
Infant Care Teacher Qualifications and Duties
(c) To be a fully qualified infant care teacher, a teacher shall have the following: (1) Completion, with passing grades, of 12 postsecondary semester or equivalent quarter units in early childhood or child development education at an accredited or approved college or university.

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 LPA observed staff 1( S1) does not have transcripts and does not have proof of taking any child development courses which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/07/2024
Plan of Correction
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Per assistant director, the current aide holds a Bachelor of Science in education from the Phillipines and will have those transcripts evaluated by an approved agency. If the transcripts are not evaluated, the Licensee will be hiring a new qualified infant teacher. Per assistant director, she will be assisting in the infant room.
Type B
Section Cited
CCR
101419.2(b)(2)
Infant Needs and Services Plan
(b) The needs and services plan shall be in writing and shall include the following: (2) Infants up to 12 months of age shall have a completed Individual Infant Sleeping Plan [LIC 9227 (3/20)], which is incorporated by reference.

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 Child 1 (C1) is missing LIC 9227 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/07/2024
Plan of Correction
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Per assistant director, she will provide the form LIC 9227 to the parent of C1 and will submit proof to LPA by POC due date.
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: 02/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/22/2024


LIC809 (FAS) - (06/04)
Page: 4 of 8
Document Has Been Signed on 02/22/2024 05:00 PM - It Cannot Be Edited


Created By: Veronica Martinez-Garza On 02/22/2024 at 02:52 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: 02/22/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101220(a)
Child's Medical Assessments
(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child.

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 LPA observed C4 is missing LIC 701 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/22/2024
Plan of Correction
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Per assistant director, she will contact the parents of C4 and ask them to submit a complete LIC 701. Proof will be submitted to LPA by POC due date.
Type B
Section Cited
CCR
101220.1(g)
Immunizations
(g) The licensee shall document each child's immunizations and shall maintain such documentation in the center for as long as the child is enrolled.

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 LPA observed C4 does not have proof of immunization which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/22/2024
Plan of Correction
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Per assistant director, she will contact the parents of C4 and ask them to submitt proof of immunizations. Proof will be submitted to LPA by POC due date.
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: 02/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/22/2024


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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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: AMERICAN MONTESSORI PRESCHOOL
FACILITY NUMBER: 198016696
VISIT DATE: 02/22/2024
NARRATIVE
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LPA observed the second classroom has some holes on the wall, spider webs on the corners of the ceiling, and the light panel covers are hanging open from one end.

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 indoors/outdoors. The facility provides water and refills children's water bottles as needed. Water bottles are also 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.

Currently, children are not using the outdoor area due to the weather. Areas around and/or under climbing equipment cushioning material to absorb a fall. LPA observed spider webs on the top corner of the swing poles and on the slides. LPA also observed all equipment was wet/dirty due to the recent rain. LPA advised assistant director to maintain the outdoor equipment in a clean and safe condition prior to children use. LPA observed the wood fence is chipping. 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. Children’s records were reviewed to ensure that Identification and Emergency form and a Needs and Services Plan are on file. LPA observed C4 is missing LIC 701 and proof of immunizations. C1 is missing LIC 702 and LIC 9227. Infant Teachers files were reviewed to ensure that teachers present are qualified. LPA observed that S1 is not a qualified infant teacher and does not have any child development units. Per assistant director, S1 has a Bachelor of Science in education from the Philippines; however, there are no transcripts available for review. Criminal Records Clearance for adults and verification of CPR/First Aid and health preventative practices documentation was reviewed. Assistant director’s pediatric CPR/FA expires on 09/2024.

SB792 Immunization Requirements for Staff and Employees was discussed. Staff have proof of immunizations.

AB1207 Mandated Child Abuse Reporting – Implementation was discussed with the assistant director. Website provided: http://mandatedreporterca.com/. Staff have proof of a current mandated reporter training.

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

DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024
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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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: AMERICAN MONTESSORI PRESCHOOL
FACILITY NUMBER: 198016696
VISIT DATE: 02/22/2024
NARRATIVE
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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 02/22/24 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.

Also, LPA Veronica MartinezGarza informed the Assistant Director Vlasta Blaha to provide a copy of this licensing report dated 02/22/24 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.

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

DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024
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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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: AMERICAN MONTESSORI PRESCHOOL
FACILITY NUMBER: 198016696
VISIT DATE: 02/22/2024
NARRATIVE
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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 provided.

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

DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024
LIC809 (FAS) - (06/04)
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