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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313622397
Report Date: 10/18/2022
Date Signed: 10/18/2022 02:08:09 PM

Document Has Been Signed on 10/18/2022 02:08 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:STERLING MONTESSORI (PS)FACILITY NUMBER:
313622397
ADMINISTRATOR:PAOLO SARMIENTOFACILITY TYPE:
850
ADDRESS:821 STERLING PARKWAY, STE 200TELEPHONE:
(916) 434-7000
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY: 58TOTAL ENROLLED CHILDREN: 58CENSUS: 16DATE:
10/18/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Paolo SarmientoTIME COMPLETED:
02:30 PM
NARRATIVE
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Licensing Analyst Blesi was conducting a complaint inspection today when LPA overheard staff telling children to "fling" their hands dry after washing hands due to there were no paper towels available to dry children's hands. While in the bathroom, LPA observed a toilet missing the water tank cover.

Deficiencies are noted on the following page LIC 809-D.
Appeal Rights provided
Exit interview with Paolo Sarmiento
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Amanda Blesi
LICENSING EVALUATOR SIGNATURE: DATE: 10/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/18/2022
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 10/18/2022 02:08 PM - It Cannot Be Edited


Created By: Amanda Blesi On 10/18/2022 at 12:56 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: STERLING MONTESSORI (PS)
FACILITY NUMBER: 313622397

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/18/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/18/2022
Section Cited
CCR
101239(e)(4)

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Fixtures and Furniture: All toilets, handwashing and bathing facilities shall be maintained in safe and sanitary operating condition.
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Paolo states he has ordered the part to replace the cover on the toilet and expects it to arrived shortly. LPA shall make a return visit to verify the deficiency has been corrected.
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This requirement was not met as evidenced by: LPA observed a toilet missing the cover on the water tank. This poses a potential heatlh and safety risk to children in care.
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Type B
11/18/2022
Section Cited
CCR101638.1(d)(4)

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GENERAL SANITATION:The following Hand washing procedures shall be used: Dry hands with disposable paper towels.Only disposable paper towels in an appropriate holder or dispenser shall be used.
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LPA discussed with Paolo the need to have paper towels available for children to dry their hands after washing them. Paolo states there are paper towels in the other bathroom and he has ordered more but they have not arrived yet. To correct the deficiency, Paolo shall restock the paper towel dispenser in the preschool bathroom.
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This requirement was not met when LPA overheard staff telling children to fling the water off their hands to dry them because there were no paper towels available in the dispenser.
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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:Amanda Blesi
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2022


LIC809 (FAS) - (06/04)
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