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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700059
Report Date: 02/17/2022
Date Signed: 02/17/2022 02:44:07 PM

Document Has Been Signed on 02/17/2022 02:44 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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:MONTESSORI SCHOOL OF OCEANSIDE #2FACILITY NUMBER:
376700059
ADMINISTRATOR:MENDOZA, SYLVIAFACILITY TYPE:
850
ADDRESS:4760 OCEANSIDE BLVD., #B10TELEPHONE:
(760) 724-8955
CITY:OCEANSIDESTATE: CAZIP CODE:
92056
CAPACITY: 43TOTAL ENROLLED CHILDREN: 43CENSUS: 27DATE:
02/17/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:49 PM
MET WITH:Sylvia MendozaTIME COMPLETED:
02:43 PM
NARRATIVE
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A case management visit was made today. Licensing Program Analyst O.Cameron observed the following Title 22 code of regulation deficiencies:

See LIC 809-D for deficiencies.

An exit interview was conducted, a copy of this report ,and appeals rights were given to the Director Sylvia Mendoza.


A copy of this report was provided along with a notice of site visit.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Otsanya Cameron
LICENSING EVALUATOR SIGNATURE: DATE: 02/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/17/2022
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 02/17/2022 02:44 PM - It Cannot Be Edited


Created By: Otsanya Cameron On 02/17/2022 at 02:00 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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: MONTESSORI SCHOOL OF OCEANSIDE #2
FACILITY NUMBER: 376700059

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/17/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/28/2022
Section Cited
CCR
101173(d)

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101173 Plan of Operation
(d) The child care center shall operate in accordance with the terms specified in the plan of operation.

This requirement was not met as evidenced by:
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Licensee states that due to insufficient staffing she attempted to maintain ratio by taking the 4 non napping children with her off site, However, Licensee states will hire more staff to ensure appropriate staffing requirement is met.
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Based on observation and record review, director did not comply to meet regulation cited above as 4 of 27 preschool children were present in an "off limit/unlicensed" area attached to the preschool.
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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:Pauline Beschorner
LICENSING EVALUATOR NAME:Otsanya Cameron
LICENSING EVALUATOR SIGNATURE:
DATE: 02/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/17/2022


LIC809 (FAS) - (06/04)
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