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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372001507
Report Date: 04/26/2022
Date Signed: 04/26/2022 02:10:54 PM

Document Has Been Signed on 04/26/2022 02:10 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:MONTESSORI CHILD DEVELOPMENT CENTER OF CALIFORNIAFACILITY NUMBER:
372001507
ADMINISTRATOR:MARIJANE SCHAFERFACILITY TYPE:
850
ADDRESS:14911 ESPOLA ROADTELEPHONE:
(858) 748-1727
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY: 70TOTAL ENROLLED CHILDREN: 44CENSUS: 41DATE:
04/26/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Maureen SchwersenskiTIME COMPLETED:
02:20 PM
NARRATIVE
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On April 26, 2022 at 1:00 p.m. Licensing Program Analyst (LPA) Leilani Curtis conducted an unannounced case management inspection. Upon arrival LPA met with Director Maureen Schwersensky and proceeded to tour the facility. There were 41 children with 5 staff members present. Appropriate ratio/capacity was observed. Staff members have the required background clearances and are associated to the facility.

On 2/14/22 Director Maureen Schwersensky advised LPA that there were several daycare children and staff in the facility that were diagnosed positive for Covid-19 during the month January 2022. The director notified LPA of 6 positive Covid-19 cases while LPA was at the facility on 2/14/22 and an additional two positive cases later that same day via email. On April 25, 2022 the director notified LPA of an additional positive Covid-19 case that occurred in January 2022. Ms. Schwersensky stated that she did not report the positive cases to Community Care Licensing within the required time period because she was not aware of the reporting requirement. The director also stated that the LIC624, Unusual Incident form was not submitted within 7 days of the incident (positive diagnosis).

See LIC809D for cited deficiency.

An exit interview was conducted with the director and appeal rights (LIC 9058 1/16) were discussed. The director’s signature on this form acknowledges receipt of these rights. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS. LPA and LPM observed the director post notice of site visit.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Grace Curtis
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2022
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 04/26/2022 02:10 PM - It Cannot Be Edited


Created By: Grace Curtis On 04/26/2022 at 11:44 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
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: MONTESSORI CHILD DEVELOPMENT CENTER OF CALIFORNIA
FACILITY NUMBER: 372001507

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/06/2022
Section Cited
CCR
101212(d)(1)(C)

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101212 Reporting Requirements:(d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. Also, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days...(1) Events reported shall include the following:(C) Any unusual incident... This requirement was not met as evidenced by:
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The director states that she will watch the video entitled Child Care Reporting Requirements on the Community Care Licensing website (www.ccld.ca.gov) and submit a signed and dated summary about reporting requirements via email to LPA by POC due date 5/6/22.
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Based on LPA interview with the director, the director failed to notify Community Care Licensing of positive Covid-19 cases during the month January 2022. This poses a potential health and safety risk to children in care.
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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:Tashima Daniel
LICENSING EVALUATOR NAME:Grace Curtis
LICENSING EVALUATOR SIGNATURE:
DATE: 04/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/26/2022


LIC809 (FAS) - (06/04)
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