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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364842076
Report Date: 02/04/2025
Date Signed: 02/04/2025 12:53:40 PM

Document Has Been Signed on 02/04/2025 12:53 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:ST. MARY'S MONTESSORI SCHOOLFACILITY NUMBER:
364842076
ADMINISTRATOR/
DIRECTOR:		DESERRE JONESFACILITY TYPE:
830
ADDRESS:6880 N VICTORIA WINDROWS LOOPTELEPHONE:
(909) 200-2727
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91739
CAPACITY: 28TOTAL ENROLLED CHILDREN: 26CENSUS: 23DATE:
02/04/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:20 AM
MET WITH:Deserre JonesTIME VISIT/
INSPECTION COMPLETED:
01:20 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 2/4/25 at 11:20 am, Licensing Program Analyst (LPA) Patricia Berry a case management visit conducted in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 1/28/25. It indicates a child sustained a dislocated arm. Staff was interviewed and video footage was viewed.

LPA viewed the video footage and observed the child pulling on a staff member’s arm. Video footage showed the staff member then hold onto both child’s arms with a swinging motion while both staff and child smiling. Video footage showed the child sit on the ground and hold their right arm crying. LPA interviewed the staff member and staff member stated the child wanted to play and the staff member was playing while holding onto both of child’s arms. Staff member stated she observed the child sit on the ground and hold the right arm in discomfort. The director called the parents right away, self reported the incident to Community Care Licensing, immediately and sent video footage. LPA reviewed the child’s file; on the physician’s report and there is no mention of any type of prior medical conditions to be aware of. Based on information gathered, the facility acted appropriately, and no violations has been identified.

An exit interview was conducted, and a copy of this report, appeal rights 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: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/04/2025
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 1