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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371474
Report Date: 04/17/2024
Date Signed: 04/17/2024 03:38:03 PM


Document Has Been Signed on 04/17/2024 03:38 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:BUENA PARK MONTESSORI ACADEMYFACILITY NUMBER:
304371474
ADMINISTRATOR:ROXANA C. DOMINGUEZFACILITY TYPE:
850
ADDRESS:6221 LINCOLN AVENUETELEPHONE:
(714) 821-7800
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY:78CENSUS: 50DATE:
04/17/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:29 PM
MET WITH:Roxana Dominguez - DirectorTIME COMPLETED:
03:45 PM
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An unannounced case management report was initiated on today’s date by Licensing Program Analyst (LPA) Odom, during a complaint investigation it was discovered that the facility did not have a substitute list in case of emergency.

During today's inspection there was 50 preschool and 4 staff members in the classroom, preschool children were napping. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios.

A review of staff 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 complaint investigation, Staff #1 (S1) did not have a back up substitute list of qualified teachers in case of emergency situations. On 3/11/24, 3/12/24, 3/13/24, and 3/14/24 the facility did not have a preschool opener between the hours of 6:30am to 7:30am. On all 4 days there were preschool age children that arrived and were dropped off at the childcare center between the hours of 6:50am to 7:20am.

Licensee will be cited under the California Code of Regulations, Title 22, Division 12, Chapter 1, Section 101216.3( e)(1) Teacher-Child Ratio. See attached LIC 809D.

Exit interview was conducted with Director Roxana Dominguez and Assistant Director Shymali Perera. Notice of Site Visit was posted during the visit. Licensee was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Carmen OdomTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:
DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/17/2024
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 04/17/2024 03:38 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868


FACILITY NAME: BUENA PARK MONTESSORI ACADEMY
FACILITY NUMBER: 304371474

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/17/2024
Section Cited
CCR
101216.3(e)(1)

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101216.3 Teacher-Child Ratio
(e) Each licensee shall maintain an up-to-date list of qualified teacher substitutes... (1). Substitutes on this list shall be called immediately in case of emergency or illness to meet the teacher-child ratios required by this chapter. This requirement was not met as evidence by:
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Director stated they are opening an account with ChildCare Careers to be able to hire substitute staff in case of emergencies. Three staff have also been hired and planning to hire 1 more as a floater. Director will submit a written POC by 4/18/24.
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Based on records reviewed, facility did not have a substitute list for backup staff in case of an emergency in which, the facility did not have a preschool opener on 3/12/24, 3/13/24, and 3/14/24. This poses a potential health and safety risk to the children in care.
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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: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Carmen OdomTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:
DATE: 04/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/17/2024
LIC809 (FAS) - (06/04)
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