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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364841885
Report Date: 11/09/2023
Date Signed: 11/09/2023 04:23:41 PM

Document Has Been Signed on 11/09/2023 04:23 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:EMILY TURNERFACILITY TYPE:
850
ADDRESS:6880 N VICTORIA WINDROWS LOOPTELEPHONE:
(909) 200-2727
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91739
CAPACITY: 209TOTAL ENROLLED CHILDREN: 209CENSUS: 44DATE:
11/09/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:48 AM
MET WITH:Emily Turner/administrationTIME COMPLETED:
04:40 AM
NARRATIVE
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On 11/9/23 at 3:48 pm, Licensing Program Analyst's (LPAs) Patricia Berry and Claudia Caywood conducted a Case Management visit in response to two self reported incidents (UIR’s), which were received on 10/11/23 and 10/13/23. LPAs met with Emily Turner. LPA toured the facility and took census.

The first incident occurred on 10/11/23. Staff stated during pick-up time, staff accidentally released a child to the wrong authorized representative. Staff stated after immediately releasing the child, they quickly realized the mistake. Another parent saw the child and stayed with the child, as the child’s parent was walking up to get the child.

The second incident occurred on 10/13/23. Staff stated during Grandparent’s Day at the school, while outside in the playground, a staff member accidentally left a child with another child’s authorized representative while the staff member went inside to put away chairs.

After both incidents, the facility immediately reported the incidents to the Department. On 10/19/23, the facility conducted Supervision and Safety training for all staff, The training consisted of teacher to child ratios, child check in and out procedures, name to face logs, and what to do after an event when authorized representatives are leaving. The training and a list of participants were provided to the Department on 10/25/23.

During today’s visit, LPA interviewed all pertinent parties, including staff. Staff corroborated what was reported. Based on what was reported by the facility and LPA’s interviews conducted, both incidents resulted in a violation of Title 22 regulations.

See 809D for deficiency.

An exit interview was conducted with the administration, and a copy of this report was provided, appeal right and notice of site visit and acknowledgement of receipt provided. Notice of site visit must be posted for 30 days.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Patricia Berry
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2023
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 11/09/2023 04:23 PM - It Cannot Be Edited


Created By: Patricia Berry On 11/09/2023 at 07:06 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: 11/09/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/09/2023
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 shall be left without... supervision... ... shall include visual observation
This requirement was not met as evidenced by
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The director immediately corrected both incidents.The director completed Supervision and Safety training on 10/13/23. The director reported both incidents to CCL.
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Based on what was reported by the facility and interviews conducted with staff there was a violation to Title 22 regulations.

This is an immediate health, safety and persona rights risk to children in care
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Director stated she will send hourly supervision academic day name to face logs from 8:30 amd to 3:15 pm for 11/9/23 and send to CCL by 11/13/23.

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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: 11/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/09/2023


LIC809 (FAS) - (06/04)
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