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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334840766
Report Date: 08/27/2024
Date Signed: 08/27/2024 04:09:59 PM

Document Has Been Signed on 08/27/2024 04:09 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:SCHOOL TIME MONTESSORIFACILITY NUMBER:
334840766
ADMINISTRATOR/
DIRECTOR:		MONICA G. MACIELFACILITY TYPE:
850
ADDRESS:10235 WELLS DRIVETELEPHONE:
(951) 689-1151
CITY:RIVERSIDESTATE: CAZIP CODE:
92503
CAPACITY: 89TOTAL ENROLLED CHILDREN: 89CENSUS: 18DATE:
08/27/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:00 PM
MET WITH:Monica MacielTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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
On the date and time listed above a case management visit was completed by Licensing Program Analyst (LPA) Giselle Carbullido due to deficiencies found during the course of another inspection.

1) Reporting Requirements: Facility did not report to Community Care Licensing an unusual incident that occurred on 08/21/24 by telephone or fax to the department by the next business day (24 hours) including submission of a written Unusual incident report (LIC624) per CCR Title 22 regulations.
SEE LIC 809D for the deficiency cited.

An exit interview was conducted, a copy of this report and Notice of Site Visit were provided to the facility representative Monica Maciel. LPA observed the Notice of Site Visit form was posted by staff. THIS REPORT MUST BE AVAILABLE TO THE PUBLIC UPON REQUEST FOR THREE YEARS.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE: DATE: 08/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/27/2024
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 08/27/2024 04:09 PM - It Cannot Be Edited


Created By: Giselle Carbullido On 08/27/2024 at 02:52 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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: SCHOOL TIME MONTESSORI
FACILITY NUMBER: 334840766

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/29/2024
Section Cited
CCR
101212(d)((1)(C)

1
2
3
4
5
6
7
Reporting requirements: 101212(d)((1)(C)-Any unusual incident or child absence that threatens the physical or emotional health or safety of any child. This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Director will submit an unusual incident report for 08/21/24 by POC due date 08/29/24 or earlier to the department.
8
9
10
11
12
13
14
Based upon LPA record review, the facility did not report an incident occurring on 08/21/24 regarding a staff/child interaction This is a potential health and safety risk to children in care.
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:Gilbert Sena
LICENSING EVALUATOR NAME:Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:
DATE: 08/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/27/2024


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