334844579-12-4-2024-09-CC-PORS-DBMW45-20241204155659

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334844579
Report Date: 12/04/2024
Date Signed: 12/04/2024 03:58:18 PM

Document Has Been Signed on 12/04/2024 03:58 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	MONTY'S MONTESSORI ACADEMY OF CALIMESA		FACILITY NUMBER:	334844579
ADMINISTRATOR/ DIRECTOR:	LISA GILFILLAN		FACILITY TYPE:	850
ADDRESS:	9580 CALIMESA BLVD		TELEPHONE:	(909) 795-2472
CITY:	CALIMESA	STATE: CA	ZIP CODE:	92320
CAPACITY: 64	TOTAL ENROLLED CHILDREN: 62	CENSUS: 51	DATE:	12/04/2024
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:27 AM
MET WITH:	Assistant Director Jennifer McClintock		TIME VISIT/ INSPECTION COMPLETED:	04:10 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, Licensing Program Analysts (LPAs) Perla Ordones and Eric Ramos arrived at the facility in response to the receipt of an Unusual Incident Report (UIR) that was submitted by the facility. The UIR was received by the licensing agency on 11/25/2024. The incident occurred on 11/14/2024 per the submitted report. LPAs were granted entrance into the facility by Assistant Director Jennifer McClintock. LPAs explained the purpose of the visit and conducted a facility tour to take census. The UIR documents an incident wherein a day-care child sustained an injury to their elbow while in care. LPAs conducted interviews with pertinent parties who stated that at the time the day-care child was sitting down with their legs in a "w" position and a staff in classroom went to assist the child in getting up. Pertinent parties stated that the staff that assisted the child pulled one of the child's arms to help them stand and that they felt a "popping" sensation while pulling the child up. According to pertinent parties, the day-care child did not make an indication they were hurt at the time of the incident and the staff that assisted the child did not see any physical injuries on the child. Pertinent parties did not state the staff asked the child if they were injured but did state the staff told the day-care child "sorry" after the incident. However, per the UIR the document states that the day-care child made a "sudden expression of pain" which was communicated to the day-care child's authorized representative. Pertinent parties stated that staff have had training, which was given before the incident, on the proper way to lift children which is to lift children under the arm pits. Pertinent parties stated training on how to lift children by the arm pits has been redone since the incident. Pertinent parties stated that the child was taken to urgent care by authorized representatives where it was confirmed the child sustained an injury to the elbow. Additionally, pertinent parties stated there is no set procedure on how to evaluate potential injuries for day-care children. Due to staff not following proper procedure to lift children and staff not properly assessing the day-care child for potential injuries, this is a violation of Title 22 regulations section 101223 - Personal Rights.

Aaron Ross	TELEPHONE: (951) 320-2023
Perla Ordones	TELEPHONE: (951) 782-4200
	DATE: 12/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: MONTY'S MONTESSORI ACADEMY OF CALIMESA	FACILITY NUMBER: 334844579
	VISIT DATE: 12/04/2024

NARRATIVE

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Additionally, per Title 22 regulations section 101212 - Reporting Requirements, UIRs "shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report... shall be submitted to the Department within seven days following the occurrence of such event". While a written report was submitted to the department, the department was not notified via telephone or fax of the incident within the next working day as required per regulations. LPAs advised Assistant Director on regulations section 101212 - Reporting Requirements.

See LIC809-D for cited deficiencies.

LPAs Perla Ordones and Eric Ramos informed Assistant Director Jennifer McClintock that this report dated 12/04/2024 document(s) one Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPAs Perla Ordones and Eric Ramos informed the Assistant Director Jennifer McClintock to provide a copy of this licensing report dated 12/04/2024 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Assistant Director Jennifer McClintock.

SUPERVISOR'S NAME: Aaron Ross	TELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Perla Ordones	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 12/04/2024 03:58 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: MONTY'S MONTESSORI ACADEMY OF CALIMESA	FACILITY NUMBER: 334844579
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

(a) The licensee shall ensure that each child is accorded the following personal rights: (3) To be free from... infliction of pain... This requirement was not met as evidenced by:
	Deficient Practice Statement
1 2 3 4
	POC Due Date: 12/05/2024
	Plan of Correction
1 2 3 4	Licensee agrees to submit an updated policy on how to assess children for injuries, conduct an in-service training on how to properly lift children, as well as submit agenda and sign in/out sheet for in-service training.

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.

Aaron Ross	TELEPHONE: (951) 320-2023
Perla Ordones	TELEPHONE: (951) 782-4200
	DATE: 12/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

LIC809 (FAS) - (06/04)

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