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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019941
Report Date: 01/07/2022
Date Signed: 01/07/2022 12:01:05 PM

Document Has Been Signed on 01/07/2022 12:01 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:DISCOVERY WORLD MONTESSORIFACILITY NUMBER:
198019941
ADMINISTRATOR:JIA JIA CHENFACILITY TYPE:
850
ADDRESS:801 BREA CANYON RDTELEPHONE:
(909) 598-5540
CITY:DIAMOND BARSTATE: CAZIP CODE:
91789
CAPACITY: 121TOTAL ENROLLED CHILDREN: 121CENSUS: 43DATE:
01/07/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Toni Espino - Director TIME COMPLETED:
12:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced in person Case Management – Deficiencies inspection. Upon arrival at 10:35am, LPA was met by Director Toni Espino, to whom the purpose of the inspection was provided. LPA was provided a tour of the facility at 10:40am.

Census was taken. There were 2 Staff and 7 Children in Room 2, 0 Staff and 0 children in Room 3, 2 Staff and 11 Children in Room 4, 2 Staff and 17 Children in Room 5, and 1 Staff and 8 Children in Room 6.



During an inspection, facility disclosed that they did not report the unusual incident of a child in care being left alone in a classroom without supervision. According to documentation of staff written statements, this occurred on 11/19/2021. Written statements disclosed that a child in a high chair was left in the classroom alone during transition when a staff member chased after another child who ran away from the group. The staff member brought the child who ran away from the group, back to the group, then returned to the classroom to retrieve the child left unattended. LPA’s interviews with staff confirmed that a child was left in a classroom unsupervised. The incident was not reported to the Department. Facility’s failure to report the above incident was a violation of Title 22 regulations, Reporting Requirements, and was discussed with the Director.

Please see attached 809D for the documentation of deficiencies.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative.

Exit interview was conducted with Director Toni Espino, at 11:55am, including copy of report.



END OF REPORT
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE: DATE: 01/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/07/2022
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 01/07/2022 12:01 PM - It Cannot Be Edited


Created By: Nolan Tcheng On 01/07/2022 at 11:21 AM
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: DISCOVERY WORLD MONTESSORI
FACILITY NUMBER: 198019941

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/07/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/14/2022
Section Cited
CCR
101212(d)(1)(C)

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Reporting Requirements
Upon the occurrence, during the operation of the child care center...a report shall be made to the Department...within the Department's next working day (1)(C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child.
This requirement was not met as evidenced by:
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Per Director, they will submit the completed LIC624 Unusual Incident Report for the incident on 11/19/2021 and submit it to LPA. They will also watch "Child Care Reporting Requirements" on ccld.childcarevideos.org and submit a summary to LPA by POC date.
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Based on interview, Staff #1 stated that the incident where a child was left unsupervised in a classroom, took place, but facility did not make any report to the Department. This poses a potential risk to the health, safety, and personal rights of 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:Christina Gabelman
LICENSING EVALUATOR NAME:Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:
DATE: 01/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/07/2022


LIC809 (FAS) - (06/04)
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