304370106-2-12-2025-06-CC-OMEA-DDU36F-20250212165817

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304370106
Report Date: 02/12/2025
Date Signed: 02/12/2025 04:58:29 PM

Document Has Been Signed on 02/12/2025 04:58 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	HILLSIDE MONTESSORI		FACILITY NUMBER:	304370106
ADMINISTRATOR/ DIRECTOR:	NADESAN, AJANTHA		FACILITY TYPE:	830
ADDRESS:	19900 EL TORO ROAD		TELEPHONE:	(949) 858-8818
CITY:	SILVERADO CANYON	STATE: CA	ZIP CODE:	92676
CAPACITY: 10	TOTAL ENROLLED CHILDREN: 67	CENSUS: 7	DATE:	02/12/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	03:00 PM
MET WITH:	Julie Labus		TIME VISIT/ INSPECTION COMPLETED:	05:15 PM

NARRATIVE

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On 2/12/2025 at 3:00pm Licensing Program Analyst (LPA) Meza and Licensing Program Manager (LPM) Malane conducted an Annual Inspection. The Director, Julie Labus led (LPA) Meza and (LPM) Malane on a tour of the facility inside and outside. There were seven (7) infants and two (2) staff. Facility hours are 7a.m.- 6p.m., Monday through Friday.

A review of the Facility Personnel Report Summary on 2/12/2025 indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During the inspection of the indoor activity space, items which could pose a danger to children (detergents, cleaning compounds, and medications) were observed to be stored out of the reach of children. Poisons/Hazardous Items are kept in a locked cabinet inaccessible to children. Food is properly stored. Menus are posted where they can be reviewed by parents. Floors, equipment, and furniture were clean and observed to be in good repair and free of sharp edges.

Facility completed testing prior to their deadline, there were no exceedances.

There is drinking water available to children indoors by water bottle and drinking fountains.

The children's restrooms are clean and sanitary. The facility has conducted an emergency drill within the past six months and keeps documentation of drills, the last disaster drill was conducted on 9/18/24. The facility has a at least one working carbon monoxide detector. Facility meets all posting requirements.

The outdoor activity space was inspected for compliance. The surface of the outdoor activity space is maintained and free of hazards. There is turf under high climbing play equipment and is sufficient to absorb falls. The outdoor equipment and toys are in good repair and free of sharp edges. Director stated that there are no bodies of water present at the facility. Drinking water in the outdoor activity space is provided by water bottles and drinking fountains.

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SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Olivia Meza
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025

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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Document Has Been Signed on 02/12/2025 04:58 PM - It Cannot Be Edited

Created By: Olivia Meza On 02/12/2025 at 03:48 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: HILLSIDE MONTESSORI	FACILITY NUMBER: 304370106
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/12/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.7995(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in one out of two staff personnal records did not have Pertusis immunization on file for review which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/14/2025
	Plan of Correction
1 2 3 4	Licensee stated that Staff 1 (S1) will submit proof to the department of pertusis immunization via email to olivia.meza@dss.ca.gov by specified due date of 3/14/25.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Martha Malane

LICENSING EVALUATOR NAME:

Olivia Meza

LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025

LIC809 (FAS) - (06/04)

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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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: HILLSIDE MONTESSORI	FACILITY NUMBER: 304370106
	VISIT DATE: 02/12/2025

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(page two)
Two (2) staff files were reviewed. Staff 1 (S1) did not have Pertussis immunization on file for review. See attached 809D for deficiency cited. At least one staff member present possesses current EMSA approved Pediatric CPR/First Aid certifications, which expires 10/2/2025.

A total of 5 Children's records were reviewed and in compliance. LPA observed and reviewed 15-minute sleep check for each infant present. Changing table is arms reach from the sink. Sign in/out procedure was reviewed for compliance. The facility utilizes Bright Wheel application for sign in and out.

Incidental Medical Services (IMS) policy was discussed. 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

The Director was informed that Licensing Quarterly Updates are available at www.cdss.ca.gov Director may request to be added to an email list to receive a Quarterly Update by contacting the Child Care Advocate at childcareadvocatesprogram@dss.ca.gov or at www.cdss.ca.gov

LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

In the areas that were evaluated, one Type B deficiency was cited per the California Code of Regulations, Title 22, Division 12 at the time of the visit.

Appeal Rights and deficiencies were discussed. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director Julie Labus.

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/process.

(end of report)

SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Olivia Meza
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025

LIC809 (FAS) - (06/04)

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