364841885-5-5-2023-09-CC-PBEY-CRJVWL-20230505164806

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364841885
Report Date: 05/05/2023
Date Signed: 05/05/2023 04:48:13 PM

Document Has Been Signed on 05/05/2023 04:48 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 SCHOOL		FACILITY NUMBER:	364841885
ADMINISTRATOR:	MARTINEZ DESERIE		FACILITY TYPE:	850
ADDRESS:	6880 N VICTORIA WINDROWS LOOP		TELEPHONE:	(909) 200-2727
CITY:	RANCHO CUCAMONGA	STATE: CA	ZIP CODE:	91739
CAPACITY: 209	TOTAL ENROLLED CHILDREN: 209	CENSUS: 61	DATE:	05/05/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Deserie Martinez/Director		TIME COMPLETED:	05:15 PM

NARRATIVE

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On 5/5/23 at 1:10 pm, Licensing Program Analyst's (LPAs) Patricia Berry and Claudia Caywood conducted a case management incident investigation in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 4/28/23. It indicates a child was left on the playground and did not go inside the classroom with the teacher. There were two teachers on the playground during the incident; however, the two teachers were on the playground with their children which is approximately 20 to 30 yards away from the were the child was left alone on the playground.

LPA's viewed video footage. LPA's observed the chid was walking around the two year old playground by themselves,without any supervision. LPA's observed a 1 1/2 minute time lapse of the child by themself on the playground before a teacher came out of the classroom to get the child.

LPA's conducted interviews with 4 teachers.Two teachers stated they had no knowledge of the child alone on the playground. The other two teachers found child after 1 1/2 minutes of being alone on the playground.

Based on the information gathered, the following violation has been identified: 101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.

See LIC809D for cited deficiency of the California Code of Regulations, Title 22, Div. 12. Civil Penally LIC 421IM repeat violation for $1,000.00 was issued.

An exit interview was conducted and a copy of this report, appeal rights, acknowledgement of receipt and notice of site visit was provided to facility staff.

Notice of Site Visit must be posted for 30 days.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Patricia Berry
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2023

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 05/05/2023 04:48 PM - It Cannot Be Edited

Created By: Patricia Berry On 05/05/2023 at 03:34 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: ST. MARY'S MONTESSORI SCHOOL	FACILITY NUMBER: 364841885
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/05/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/08/2023 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision ...(1) No child shall be left without the supervision ... at any time ... Supervision shall include visual observation. This requirement was not met as evidenced by	1 2 3 4 5 6 7	Staff retrieved the child from the playground. Director informed the parent. Director stated she changed name to face procedure from digital to paper and conducted a training on transitions and supervision on 5/3/23. Director implemented daily safety and
	8 9 10 11 12 13 14	Based on vdeo footage and interviews conducted a child was left alone on the playground This is an immediate health and safety risk to the children in care Civil Penally LIC 421IM repeat violation for $1,000.00was issued.	8 9 10 11 12 13 14	supervision email on 5/1 that is required to be acknowledged by all staff. Director stated she will send a list of signatures confirming acknowledgment of the email and send to CCL 5/8/23.
	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: 05/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2023

LIC809 (FAS) - (06/04)

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