<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370921
Report Date: 10/24/2022
Date Signed: 10/24/2022 10:45:32 AM

Document Has Been Signed on 10/24/2022 10:45 AM - 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:MONTESSORI LEARNING CENTERFACILITY NUMBER:
304370921
ADMINISTRATOR:DAVIS, JEANNETTEFACILITY TYPE:
850
ADDRESS:331 NORTH HARBOR BLVD.TELEPHONE:
(714) 999-6618
CITY:ANAHEIMSTATE: CAZIP CODE:
92805
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 17DATE:
10/24/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Jeannette Davis, DirectorTIME COMPLETED:
11:15 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPA) Mila Quinto conducted an unannounced case management to the facility. LPA met with director Jeannette Davis. A tour around the facility was conducted, and a census was taken. LPA observed a total of 17 children and 3 staff members in different classrooms.

A review of staff criminal clearance records on this date indicated that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During the inspection on 9/19/22, the director stated there were 3 cases of children with hand foot mouth disease. According to the director, was not aware of the reporting requirement as this is a common disease.

Based on the interview with the Director, the facility did not report the incident of the 3 children with hand foot mouth disease. The facility is required to report any and all unusual incident to Community Care Licensing the next business day and follow up with a written report within 7 days. Therefore, the facility failed to meet the reporting requirements.

Based on LPA’s interview with the Director and record review, the following violation were observed and is being cited in accordance with California Code of Regulations, Title 22, Division 12, Chapter 1, Reporting Requirement Section 101212(d)(1)(E), is being cited on the attached LIC 809D.

Exit interview was conducted. The notice of site visit was posted. Licensee was informed the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalty of $100. Appeal Rights was explained. A copy of appeal rights (LIC 9058 1/16) was provided and their signatures on this form acknowledges receipt of these rights. First level appeal is to Regional Manager, address is above on the report.

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 10/24/2022 10:45 AM - It Cannot Be Edited


Created By: Mila Quinto On 10/24/2022 at 10:08 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MONTESSORI LEARNING CENTER
FACILITY NUMBER: 304370921

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/24/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/24/2022
Section Cited
CCR
101212(d)(1)(E)

1
2
3
4
5
6
7
101212 Reporting Requirement d)(1) a report shall be made to the Department by telephone or fax within the Department's... (E) Epidemic outbreaks.
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
The Director will review Title 22 Reporting Requirements and will be submitting written notice to licensing. Director understands to notify Licensing when there is an outbreak in the facility. The director will email LPA for plan to correct the deficiency by end of business day today, October 24, 2022. Director will also review Public Health Reporting Requirements.
8
9
10
11
12
13
14
Based on interview and record review, Director did not report the hand/foot/mouth disease when there were more than 2 cases of the outbreak.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Patricia Magana
LICENSING EVALUATOR NAME:Mila Quinto
LICENSING EVALUATOR SIGNATURE:
DATE: 10/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/24/2022


LIC809 (FAS) - (06/04)
Page: 2 of 2