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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293619869
Report Date: 05/25/2023
Date Signed: 05/25/2023 04:12:41 PM

Document Has Been Signed on 05/25/2023 04:12 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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:MONTESSORI HOUSE OF CHILDRENFACILITY NUMBER:
293619869
ADMINISTRATOR:PETTY, SUSANNAFACILITY TYPE:
850
ADDRESS:12509 BURMA RDTELEPHONE:
(530) 274-7938
CITY:GRASS VALLEYSTATE: CAZIP CODE:
95945
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 13DATE:
05/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Callie Quintel and Susanna PettyTIME COMPLETED:
04:20 PM
NARRATIVE
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At approximately 2:20pm, Licensing Program Analyst (LPA) Matthew Gallo met with teacher Callie Quintel for the purpose of an unannounced annual random inspection. At that time, LPA counted a census of 13 preschool children supervised by 2 staff. Director Susanna Petty arrived at approximately 3:30pm. Facility hours of operation are 8am-4pm Monday-Thursday, and 8am-3pm on Friday. Facility does not offer transportation services.

LPA toured the building including all activity and classroom spaces, restrooms, food service and outdoor play areas. All necessary postings were observed. Director stated there were no firearms on the premises, and LPA did not observe any bodies of water. Functional carbon monoxide detector and smoke detector were present. Furniture and equipment were in good condition, and floors were clean throughout the facility. Playground equipment and surfaces were free of loose or sharp parts, and the areas underneath or around climbing equipment were sufficiently cushioned with wood chips. Program provides AM and PM snacks, and menus were posted in visible sight. The food preparation space was free of litter and all food was protected against contamination. Storage containers with solid waste had tight-fitting covers. Drinking water was readily available to children both indoors and outdoors. LPA observed full legal signatures while reviewing the sign in and sign out sheet, Medication was properly stored and inaccessible to children. Sufficient napping equipment was available.

Upon inspecting outdoor shed in the playground yard, LPA observed it to be unlocked and accessible. Inside, LPA observed tanks of gasoline on the ground and Roundup herbicide stored on a high shelf out of reach of children.

Children's records were reviewed and observed to be complete. Pediatric CPR and First Aid certification was verified, though a review of staff files revealed that no present staff had record of their most recent AB1207 Mandated Reporter Training certificates.

Report Continues on 809-C

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
RIVER CITY (SACTO)CC, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: MONTESSORI HOUSE OF CHILDREN
FACILITY NUMBER: 293619869
VISIT DATE: 05/25/2023
NARRATIVE
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Criminal record clearances were also verified, and facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA reviewed the Department's inspection authority and discussed with designee any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

LPA discussed Assembly Bill 2370, which will require licensed Child Care facilities to test their water for excessive amounts of lead and verified facility compliance.

Director was encouraged to the visit the departments website at WWW.CCLD.CA.GOV for information regarding childcare updates, forms, regulations and legislation pertaining child care centers.

Title 22 deficiencies are cited on the subsequent pages of this report.


Licensee acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 809D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee. LIC 9224 provided.

Exit interview conducted and report was reviewed with Director Susanna Petty. Appeal rights and a Notice of Site Visit were provided, the latter of which must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Matthew Gallo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023
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Page: 2 of 4
Document Has Been Signed on 05/25/2023 04:12 PM - It Cannot Be Edited


Created By: Matthew Gallo On 05/25/2023 at 04:01 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
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: MONTESSORI HOUSE OF CHILDREN
FACILITY NUMBER: 293619869

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/25/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101238(g)
Buildings and Grounds
(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children.

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 by failing to ensure a shed with a inconsistent lock and containing gasonline and herbicide was indeed locked and inaccessible to children. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/26/2023
Plan of Correction
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Licensee corrected deficiency by locking shed while LPA was present with the lock currently on the shed. Licensee will install another lock on the door to ensure the shed remains inaccessible.
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:Keven Peters
LICENSING EVALUATOR NAME:Matthew Gallo
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2023


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 05/25/2023 04:12 PM - It Cannot Be Edited


Created By: Matthew Gallo On 05/25/2023 at 04:01 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
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: MONTESSORI HOUSE OF CHILDREN
FACILITY NUMBER: 293619869

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/25/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interview, the licensee did not comply with the section cited above in 3 out of 3 cases of staff member records which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/08/2023
Plan of Correction
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Licensee will ensure all staff will complete AB1207 mandated reporter training and will send LPA Gallo photos of completed certificates by the 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:Keven Peters
LICENSING EVALUATOR NAME:Matthew Gallo
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2023


LIC809 (FAS) - (06/04)
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