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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020806
Report Date: 10/06/2025
Date Signed: 10/06/2025 02:22:12 PM

Document Has Been Signed on 10/06/2025 02:22 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:OAK KNOLL MONTESSORI SCHOOLFACILITY NUMBER:
198020806
ADMINISTRATOR/
DIRECTOR:		KIRA DONNELLYFACILITY TYPE:
850
ADDRESS:904 & 914 E CLAREMONT STTELEPHONE:
(626) 345-9929
CITY:PASADENASTATE: CAZIP CODE:
91104
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 9DATE:
10/06/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Director of Operations, Korina NavarroTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
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On October 6, 2025, Licensing Program Analysts (LPA) Priscilla Ochoa conducted an unannounced case management inspection for the above facility. LPA was greeted by Director of Operations, Korina Navarro who guided LPA on a tour of the facility. The purpose of this inspection is to follow up on a self-reported incident that occurred at the facility on 09/12/2025. This is a preschool program with a toddler component that operates Monday – Friday from 8:15 am – 4:30 pm. There is another Preschool license on the property #198006504. There are currently 9 children enrolled in the program and LPA observed 9 children in care with 2 staff members.

Brief summary of incident: Child #1 (C1) was riding a tricycle on the bike path when C1 hit C1's forehead on a flowerpot when trying to get off the tricycle. Staff #1 (S1) was in the area and observed C1 fall off the tricycle, but did not witness the impact. Based interviewed with S1 – Staff #5 (S5) there was no object nor material on the floor causing the C1 to crash and fall on the flowerpot. C1 did require first aid and was applied by S5. S5 applied pressure to the affected area to minimize the bleeding. C1’s parents were called and taken to the hospital where C1 received 2 stitches right in between his eyes. Proper protocols were taken to assist the child.

In course of the investigation, LPA interviewed the Director and Staff #1 (S1) – Staff #5 (S5). LPA attempted to interview C1, however C1 refused to speak with LPA.

LPA toured the playground where the incident took place and did not observe any tripping hazards or materials that can pose a danger to children in care.

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NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Priscilla Ochoa
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 10/06/2025 02:22 PM - It Cannot Be Edited


Created By: Priscilla Ochoa On 10/06/2025 at 10:16 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: OAK KNOLL MONTESSORI SCHOOL
FACILITY NUMBER: 198020806

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/07/2025
Section Cited
CCR
101161(a)

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(a) A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.

this requirement was not met as evidenced by
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Director of operations will stop commingling the toddlers from both licenses. Director will also provide a declaration stating that they understand that they cannot commingle with toddlers from a different license.
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as toddlers from #198006504 were commingling with toddlers from the above facility during outdoor play time causing the facility to go over capacity.
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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.
Ana Chico
NAME OF LICENSING PROGRAM MANAGER:
Priscilla Ochoa
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/06/2025


LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 10/06/2025 02:22 PM - It Cannot Be Edited


Created By: Priscilla Ochoa On 10/06/2025 at 12:34 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: OAK KNOLL MONTESSORI SCHOOL
FACILITY NUMBER: 198020806

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/10/2025
Section Cited
CCR
101229(a)(1)

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(a) The licensee shall provide care and supervision as necessary to meet the children's needs.(1)No child(ren) shall be left without the supervision of a teacher at any time...Supervision shall include visual observation.
this requirement was not met as evidenced by
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The Director will conduct a staff meeting to go over supervision protocols to ensure that all children are supervisioned at all times. Director will send LPA meeting agenda and staff sign in sheet by POC date of 10/17/25
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Based on interviews conducted and observations, although there were staff on the playground and aid provided immediately, staff did not witness the actual impact of the C1 getting hurt.
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Type B
10/10/2025
Section Cited
CCR101212(d)

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(d) Upon the occurrence, during the operation of the child care center...specified in (d)(1)..., a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours...
this requirement was not met as evidenced by
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Facility will write a declaration stating that they understand and will follow title 22 reporting requirements.

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Facility did not report the unusual incident report in a timely manner as the incident occurred on 9/12/2025 and facility reported the incident to the department via email on 9/16/2025
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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.
Ana Chico
NAME OF LICENSING PROGRAM MANAGER:
Priscilla Ochoa
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/06/2025


LIC809 (FAS) - (06/04)
Page: 4 of 5
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: OAK KNOLL MONTESSORI SCHOOL
FACILITY NUMBER: 198020806
VISIT DATE: 10/06/2025
NARRATIVE
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Based on interviews conducted and observations, although there were staff on the playground and aid provided immediately, staff did not witness the actual impact of the C1 getting hurt.

During interview with Director, it was mentioned that toddlers from #198006504 were also on the playground during the time of the incident. LPA identified that there were 19 toddlers with 2 toddler teachers and 2 assistants on the playground during the incident. LPA explained to the Director that toddlers from each license should not be commingling with one another during daycare hours. Each program has their own designated play yard that they should be using. 19 toddlers on the play yard excited the capacity of the facility. LPA also communicated to the Director that the facility did not inform the department of the unusual incident in a timely manner as described in title 22 regulation. Per title 22 regulations, the facility must inform the department of unusual incidents within 24 hours of the incident and have 7 days to submit their written report.

LPA P. Ochoa informed Director of Operations, Korina Navarro that this report dated October 6, 2025 documents 1 Type A citation 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 P. Ochoa informed the Director of Operations, Korina Navarro to provide a copy of this licensing report dated October 6, 2025 that documents any Type A citation 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. Based on the LPA’s observations and record review, the additional deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health and safety.

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

An exit interview was conducted, and a copy of this report was provided to Director of Operations, Korina Navarro.

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NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Priscilla Ochoa
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2025
LIC809 (FAS) - (06/04)
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