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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 240403488
Report Date: 12/04/2023
Date Signed: 12/04/2023 01:09:51 PM

Document Has Been Signed on 12/04/2023 01:09 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
FRESNO-CC, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:MERCED MONTESSORI SCHOOLFACILITY NUMBER:
240403488
ADMINISTRATOR:MACDONALD ANNFACILITY TYPE:
850
ADDRESS:424 W 21ST STREETTELEPHONE:
(209) 722-9823
CITY:MERCEDSTATE: CAZIP CODE:
95340
CAPACITY: 44TOTAL ENROLLED CHILDREN: 44CENSUS: 21DATE:
12/04/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Ann MacdonaldTIME COMPLETED:
01:30 PM
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On 12/4/23, Licensing Program Analyst (LPA) Priscilla Zamudio conducted an unannounced case management inspection. LPA met with Licensee, Ann Macdonald to discuss an incident which occurred on 11/13/23 and a census was also taken. LPA interviewed staff, reviewed pertinent information and observed where the incident occurred.

On 11/13/23, at approximately 4:25pm, child #1 was sitting on top of a small climber, lost their balance and fell. The child landed on their right wrist. Staff helped child #1 get up and observed that child’s wrist was slightly bend and appeared swollen. Staff immediately called parent and explained what happened. The mother came to pick up child #1 and took child#1 to the hospital after leaving the school. Staff stated child#1 had experience climbing this structure, which was a little over 3 feet tall and accidently fell. The staff were in close proximity to the child but were unable to keep from falling.

Based on information gathered and observations made by LPA, there were no obvious concerns or hazards found. Staff are implementing adequate care and supervision at the facility.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, no deficiencies are cited.

Exit interview conducted and report was reviewed with Licensee, Ann Macdonald.

This report shall be made available to the public upon request. 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.
SUPERVISORS NAME: Cynthia Brannon
LICENSING EVALUATOR NAME: Priscilla Zamudio
LICENSING EVALUATOR SIGNATURE: DATE: 12/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/04/2023
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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