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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364845734
Report Date: 11/19/2024
Date Signed: 11/19/2024 05:11:37 PM

Document Has Been Signed on 11/19/2024 05:11 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:CHILDREN'S MONTESSORI SCHOOLFACILITY NUMBER:
364845734
ADMINISTRATOR/
DIRECTOR:		KIMBERLY DYKEFACILITY TYPE:
850
ADDRESS:328 WEST PHILLIPS STREETTELEPHONE:
(909) 988-7145
CITY:ONTARIOSTATE: CAZIP CODE:
91762
CAPACITY: 34TOTAL ENROLLED CHILDREN: 34CENSUS: 10DATE:
11/19/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Laura Perez, site director TIME VISIT/
INSPECTION COMPLETED:
05:35 PM
NARRATIVE
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Licensing Program Analyst (LPA), Aman Lama conducted an annual inspection. LPA was met with site director, Laura Perez and Owner, Yanping Zhang (Ella). There were 10 children present, and 2 staff. LPA toured inside and outside, and the following was observed and/or noted:

The following documents are requested to be updated of any changes made, and submit to the Riverside Regional Office (RRO) within 30 days of this report:
1. LIC 500 Personnel Report
2. LIC 610 Emergency & Disaster Plan
3. Parent Handbook/ Program Curriculum/Admission policies and procedures/ fee schedule (only if changes have been made)
4. LIC 309 Administrative Organization
5. LIC 308 Designation of Administrative Responsibility

The following items have been posted and are updated where necessary:
- License
- Emergency Disaster Plan (LIC610) and Earthquake Preparedness Checklist (LIC9148)
- Parent’s Rights Poster (PUB393)
- Personal Rights (LIC613A)
- Child Car Seat Law
- Food menu.
· The facility is operating within the limits as stated on the license.
· Ratios were met during this inspection.
· Classrooms are adequately equipped with age and size appropriate furniture and free of hazards.
· There are no weapons present at the facility.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Aman Lama
LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: CHILDREN'S MONTESSORI SCHOOL
FACILITY NUMBER: 364845734
VISIT DATE: 11/19/2024
NARRATIVE
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·No accessible bodies of water were observed by LPA at the time of this inspection. All wading pools or similar product must be emptied immediately after use and stored in an upright position.
· Children have the option to bring their own water bottles/cups from home.
· Hazards are stored where they were inaccessible to children. These include: Disinfectants, cleaning solutions and other items that are dangerous to the health and safety of children in care.
· Poisons and toxins are to be kept locked and were observed inaccessible, per Title 22 Regulations.
· All floors were observed clean and safe, and shall remain so at all times.
· Restrooms were observed to be sanitary and in operating condition.
· Playgrounds are enclosed by appropriate fences.
· Outdoor activity areas are in good condition and supplied with age/size appropriate equipment.
· The areas around or under high climbing equipment, swings, slides, and similar equipment were cushioned with material that absorbs a fall.
· Food preparation area is clean, free of litter, rubbish and free of rodents and other vermin.
· Food is stored appropriately and protected from contamination.
· Menus were posted with date included and were placed in a visible location of children’s authorized representatives. Menus shall be kept on file for 30 days, and made available upon request.
· All storage containers for solid waste, including moveable bins have tight-fitting covers that were observed on and in good repair.
· Sign in/Sign out record was reviewed and meets regulation requirements.
· There is one staff present with a current CPR/First Aid on file.
· A review of children’s records were found to be incomplete during this inspection.
· Disaster drills are to be conducted every six months – last drill was conducted on 12/14/23.
· The facility is informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov
· A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
· The facility can submit transfer forms to associate or disassociate someone from their facility at: Associations_Disassociations862@dss.ca.gov
· A review of staff records indicates that staff that were present meet minimum qualifications for the position for which they were hired.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Aman Lama
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: CHILDREN'S MONTESSORI SCHOOL
FACILITY NUMBER: 364845734
VISIT DATE: 11/19/2024
NARRATIVE
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- The facility is currently providing Incidental Medical Services (IMS). LPA reviewed storage of medications and required documents needed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.

-The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

- The facility was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

- To access on-line Licensing forms & Regulations for a Child Care Center please visit: www.ccld.ca.gov.

- The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at: 951-782-4200


Citations have been issued during todays visit.
LPA conducted the exit interview and reviewed report with site director, Laura Perez.

A notice of site visit was given, posted, and must remain so for 30 consecutive days.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Aman Lama
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
LIC809 (FAS) - (06/04)
Page: 3 of 9
Document Has Been Signed on 11/19/2024 05:11 PM - It Cannot Be Edited


Created By: Aman Lama On 11/19/2024 at 03:58 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: CHILDREN'S MONTESSORI SCHOOL
FACILITY NUMBER: 364845734

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/19/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 2 out of 3 persons. 2 staff files did not have an updated Mandated Reporter Training (MRT) for "Child Care Providers". This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/20/2024
Plan of Correction
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Facility agrees to provide MRT for "Child Care Providers" for both, S1 and S2 no later than POC due date. This training can be found online, for free at mandatedreporterca.com
Type B
Section Cited
CCR
101215.1(b)
Child Care Center Director Qualifications and Duties
(b) All child care centers shall have a director.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on staffs own admission, the licensee did not comply with the section cited above. The director stated she has been here since August 2024, but did not notify the department or submit her directors packet. She did send it to a previous analyst, who no longer works for the department. The new director hoped licensing would make contact. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/20/2024
Plan of Correction
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Director agrees to submit a completed directors packet no later than the POC due date.
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:Aman Lama
LICENSING EVALUATOR SIGNATURE:
DATE: 11/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/19/2024


LIC809 (FAS) - (06/04)
Page: 4 of 9
Document Has Been Signed on 11/19/2024 05:11 PM - It Cannot Be Edited


Created By: Aman Lama On 11/19/2024 at 03:58 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: CHILDREN'S MONTESSORI SCHOOL
FACILITY NUMBER: 364845734

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/19/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101217(a)(12)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (12) Tuberculosis test documents as specified in Section 101216(g).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, 1 out of 3 staff did not have their TB test results. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/20/2024
Plan of Correction
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The facility agrees to submit proof of TB for S2, no later than POC due date.
Type B
Section Cited
CCR
101220.1(g)
Immunizations
(g) The licensee shall document each child's immunizations and shall maintain such documentation in the center for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. 1 out of 4 children did not have proof of Immunizations or enrollment in a school on file. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/20/2024
Plan of Correction
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Facility agrees to submit proof of immunizations for C2, no later than the POC due date.
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:Aman Lama
LICENSING EVALUATOR SIGNATURE:
DATE: 11/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/19/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/19/2024 05:11 PM - It Cannot Be Edited


Created By: Aman Lama On 11/19/2024 at 04:35 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: CHILDREN'S MONTESSORI SCHOOL
FACILITY NUMBER: 364845734

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/19/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
101238(g)
(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children.
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the facility did not comply with the section cited above. Room1 under the sink, LPA found a spray bottle of rubbing alcohol. In Room 2, LPA found a screw driver in a drawer, accessible to children. Additionally, LPA found 2 gallons of Bleach, "Real Kill Ant &Roach", multipurpose cleaner and other bottles with cleaning solutions in them. This is being downgraded to a "Type B" citation due to most of these items being behind a latch. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/22/2024
Plan of Correction
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Director was reminded which items to keep behind a key lock and which to keep behind latches & how to read labels to determine the difference. Director agrees to submit pictures of items behind a latch and those behind a lock.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Aman Lama
LICENSING EVALUATOR SIGNATURE:
DATE: 11/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/19/2024


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