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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364841885
Report Date: 04/12/2022
Date Signed: 04/12/2022 10:33:01 AM

Document Has Been Signed on 04/12/2022 10:33 AM - 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:ST. MARY'S MONTESSORI SCHOOLFACILITY NUMBER:
364841885
ADMINISTRATOR:MARTINEZ DESERIEFACILITY TYPE:
850
ADDRESS:6880 N VICTORIA WINDROWS LOOPTELEPHONE:
(909) 200-2727
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91739
CAPACITY: 209TOTAL ENROLLED CHILDREN: 209CENSUS: 114DATE:
04/12/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Deserie Martinez/DirectorTIME COMPLETED:
11:01 AM
NARRATIVE
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On 4/12/2022 at 9:15 am, Licensing Program Analyst (LPA) Patricia Berry conducted a case management deficiencies visit. LPA was granted access into the facility and met with the director. LPA toured facility and took a census.

It was self reported on 4/1/2022 a child was left unattended in the classroom for approximately 4 minutes. Director stated during transition time/morning drop-off a teacher was taking the children to their classrooms, and one child went into that child's classroom. The teacher assumed their was a teacher in that classroom. Director stated the assistant director saw the child in the classroom, unattended.

According to regulation 101229 Responsibility for Providing Care and Supervision (1) No child(ren) shall be left without the supervision of a teacher at any time, ...Supervision shall include visual observation.

See 809D for deficiency.

Civil Penalty LIC 421IM for $500.00 is assessed today.

Exit interview conducted with director, report, appeal rights, acknowledgment of receipt and Notice of Site Visit provided to the director.

Notice of Site Visit must be posted for 30 days.

This report must be made available to the public for three years.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Patricia Berry
LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2022
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 04/12/2022 10:33 AM - It Cannot Be Edited


Created By: Patricia Berry On 04/12/2022 at 09:49 AM
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: ST. MARY'S MONTESSORI SCHOOL
FACILITY NUMBER: 364841885

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/12/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/12/2022
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision...(1) No child(ren) shall be left without the supervision Supervision shall include visual observation.
This requirement was not met as evidenced by
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Assistant director immediately took child to child's classroom 40/1/22. Director emailed all staff regarding care and supervision on 4/01/22, and notfied child's parents, then put a plan in place for communication with one another and plan for transitions times on 4/04/22 and staff watched videos
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Based on director self-reporting the incident that a child was left unattended in the classroom.
This is an immediate risk to the health and safety of children in care.
Civil Penalty LIC421IM for $500.00 assessed today.
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 from CDSS on 4/08/22. Reminders on care and supervision are daily by director through emails. For future, director is putting together a video on scenarios of incidents that could happen in the facility regarding care and supervision.

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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:Gilbert Sena
LICENSING EVALUATOR NAME:Patricia Berry
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2022


LIC809 (FAS) - (06/04)
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