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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334844579
Report Date: 10/28/2021
Date Signed: 10/28/2021 01:14:56 PM

Document Has Been Signed on 10/28/2021 01:14 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:MONTY'S MONTESSORI ACADEMY OF CALIMESAFACILITY NUMBER:
334844579
ADMINISTRATOR:GARCIA, MONIQUEFACILITY TYPE:
850
ADDRESS:9580 CALIMESA BLVDTELEPHONE:
(909) 795-2472
CITY:CALIMESASTATE: CAZIP CODE:
92320
CAPACITY: 54TOTAL ENROLLED CHILDREN: 54CENSUS: 0DATE:
10/28/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:09 AM
MET WITH:Licensee, Lisa GilfillanTIME COMPLETED:
01:20 PM
NARRATIVE
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On 10/28/2021, Licensing Program Analyst (LPA) Destinee Hogue arrived at the facility to conduct an inspection for another purpose. During this inspection, LPA Hogue toured the facility inside and outside, took census, and reviewed facility records. There were no preschool children and staff present at the time of LPA's inspection.

During a review of facility records, there are staff members caring and supervising preschool children without an updated/renewed AB1207 Mandated Child Abuse Reporter Training certificate and without proof of MMR and Tdap immunization on file.

See LIC809D for deficiency cited per California Code of Regulations Title 22, Division 12 and Health & Safety Code.

An exit interview was conducted, and a copy of this report was provided to Licensee on this date.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Destinee Hogue
LICENSING EVALUATOR SIGNATURE: DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2021
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 10/28/2021 01:14 PM - It Cannot Be Edited


Created By: Destinee Hogue On 10/28/2021 at 12:50 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: MONTY'S MONTESSORI ACADEMY OF CALIMESA
FACILITY NUMBER: 334844579

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/28/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/29/2021
Section Cited
HSC
1596.7995(a)(1)

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(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles...

This requirement is not met as evidenced by:
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Licensee agrees to submit proof of immunizations for Staff #3 and Staff #4 by 11/29/2021 via email or mail.
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Based on facility records review, Licensee did not have proof of immunizations for Staff #3 and Staff #4 available at the time of LPA's request. Staff #3 is missing proof of Tdap and Staff #6 is missing proof of MMR. This poses a potential health, safety or personal rights risk to persons in care.
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THIS BOX IS INTENTIONALLY LEFT BLANK
Type B
11/08/2021
Section Cited
CCR1596.8662(b)(1)

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(1) On or before March 30, 2018,...a licensed child day care provider, administrator, or employee of a licensed child day care facility...shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
This requirement is not met as evidenced by:
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Licensee agrees to submit proof of renewed AB1207 Mandated Child Abuse certificates for Staff #2, Staff #3, and Staff #4.
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Based on facility records review, the licensee did not comply with the section cited above in Licensee did not have proof of AB1207 Mandated Child Abuse renewal certificates for Staff #2, Staff #3 and Staff #4. This poses a potential health, safety or personal rights risk to persons in care.
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THIS BOX IS INTENTIONALLY LEFT BLANK
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:Kimberly Williams
LICENSING EVALUATOR NAME:Destinee Hogue
LICENSING EVALUATOR SIGNATURE:
DATE: 10/28/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/28/2021


LIC809 (FAS) - (06/04)
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