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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364841885
Report Date: 03/14/2023
Date Signed: 03/14/2023 03:01:02 PM

Document Has Been Signed on 03/14/2023 03:01 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: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: 162DATE:
03/14/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:45 AM
MET WITH:Deserie Martinez/directorTIME COMPLETED:
03:30 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 3/14/23 at 12:45 pm, Licensing Program Analyst (LPA) Patricia Berry conducted a subsequent complaint investigation. LPA met with director/Deserie Martinez and was granted access into the facility. LPA toured facility and took a census.
During the course of a complaint investigation, staff stated a child was left absent of supervision. Staff stated on 8/11/22, at approximately 9:00 am, a child was left unattended in a classroom during an emergency drill for approximately 5 minutes. Administration staff admitted to not reporting the incident to Community Care Licensing..

This is a violation of California Code of Regulations, 101212 (d) Title 22, Division 12. See 809D for deficiency.


An exit interview was conducted, and appeal rights discussed. LPA Berry provided facility representative with a copy of this report, notice of site visit, and appeal rights.


A copy of this report must be made available to the public upon request for three years.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Patricia Berry
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2023
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 03/14/2023 03:01 PM - It Cannot Be Edited


Created By: Patricia Berry On 03/14/2023 at 06:53 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: 03/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/17/2023
Section Cited
CCR
101212(d)

1
2
3
4
5
6
7
Reporting Requirements (d) Upon the occurrence, during the operation of the child care center of any of the events... a report shall be made to the Department... within the Department's next working day...
This requirement was not met as evidenced
by
1
2
3
4
5
6
7
Administrator will submit the UIR to CCL and send both UIR and parent notification of the incident to CCL by 3/17/23..
8
9
10
11
12
13
14
Based on administration staff admitted to not reporting the incident to Community Care Licensing.

This is a potential risk to the health and safety of children in care
8
9
10
11
12
13
14
 Director stated she will also have a training on reporting requirements and will send list of participants and topics to CCL by 3/15/23.


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:Patricia Berry
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2023


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