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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343621676
Report Date: 12/19/2022
Date Signed: 12/19/2022 01:02:07 PM

Document Has Been Signed on 12/19/2022 01:02 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:LITTLE FLOWERS MONTESSORIFACILITY NUMBER:
343621676
ADMINISTRATOR:YIP, BONNIEFACILITY TYPE:
850
ADDRESS:7218 LAGUNA BLVDTELEPHONE:
(916) 684-5510
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 177TOTAL ENROLLED CHILDREN: 177CENSUS: 30DATE:
12/19/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Bonnie YipTIME COMPLETED:
01:30 PM
NARRATIVE
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On 12/19/2022, Licensing Program Analyst (LPA) Katy Maestas conducted a field visit for the purpose of a Case Management inspection. LPA arrived at the facility and was met by Director Bonnie Yip (D1). LPA disclosed the purpose of the inspection and was granted entrance into the facility. LPA toured the facility and observed 30 preschool-aged children being supervised by 5 adults. LPA verified that all required adults were background cleared by accessing Guardian.

On 12/14/2022, LPA was notified of the lead testing report via email. The report revealed that 5 water outlets have tested as having elevated levels of lead. The LIC 9275 nor the LIC 9276 were submitted to the Department within 2 days of testing as required by regulation; LPA has requested these documents from D1. LPA ensured that the 5 outlets have been marked as "Closed" and are inaccessible for use. D1 stated that 2 of the 3 classrooms with the affected water outlets are not currently in use and have been closed for a long term period due to COVID-19. 1 affected water outlet (water fountain) in the "Lavender" classroom is not being used; water is being served from a filtered pitcher. D1 understands that the water outlets must be remediated and re-tested.

As a result of the water testing positive for elevated levels of lead, a deficiency was cited on subsequent 809-D page. An exit interview was conducted and the report was reviewed with D1. Licensee Appeal Rights were provided to D1. A Notice of Site visit was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Nola Maestas
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2022
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 12/19/2022 01:02 PM - It Cannot Be Edited


Created By: Nola Maestas On 12/19/2022 at 12:38 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: LITTLE FLOWERS MONTESSORI
FACILITY NUMBER: 343621676

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/19/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/21/2022
Section Cited
CCR
101700.3(b)(1)

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Lead Testing (b)(1) A result which values of 5 ppb or greater shall be deemed an Action Level Exceedance. This requirement was not met as evidenced by: The water report dated 11/23/2022 revealed that the facility had elevated levels of lead in 5 water outlets.
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D1 will email LPA Maestas LIC 9275 & 9276 by 12/21/2022. The 5 outlets will be remediated and re-tested. The water report for the re-testing will be sent to the Regional Office.
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This is 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:Jeanne Smith
LICENSING EVALUATOR NAME:Nola Maestas
LICENSING EVALUATOR SIGNATURE:
DATE: 12/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/19/2022


LIC809 (FAS) - (06/04)
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