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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700060
Report Date: 11/05/2021
Date Signed: 11/05/2021 12:45:07 PM

Document Has Been Signed on 11/05/2021 12:45 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 #2 - INFANTFACILITY NUMBER:
376700060
ADMINISTRATOR:MENDOZA, SYLVIAFACILITY TYPE:
830
ADDRESS:4760 OCEANSIDE BLVD., #B10TELEPHONE:
(760) 724-8955
CITY:OCEANSIDESTATE: CAZIP CODE:
92056
CAPACITY: 22TOTAL ENROLLED CHILDREN: 22CENSUS: 16DATE:
11/05/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:17 PM
MET WITH: Silvia MendozaTIME COMPLETED:
12:58 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
A case management visit was made today. During the visit, 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: 11/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2021
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 2
Document Has Been Signed on 11/05/2021 12:45 PM - It Cannot Be Edited


Created By: Otsanya Cameron On 11/05/2021 at 12:21 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 - INFANT
FACILITY NUMBER: 376700060

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/05/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/15/2021
Section Cited
CCR
101427(h)

1
2
3
4
5
6
7

Infant Care Food Service
(h) Infants who are unable to hold a bottle shall be held by a staff person or other adult for bottle feeding. At no time shall a bottle be propped for an infant.

This requirement was not met as evidenced by:
1
2
3
4
5
6
7

The director has agreed to conduct a training on infant feeding with staff and submit a copy of the training agenda and the sign in sheet of the staff to who attended the training. The director agrees to submit correction to CCL by 11-15-21.
8
9
10
11
12
13
14
Based on LPA's observation, licensee did not ensure infant care food service was followed. LPA observed 1 infant resting on a boppy pillow with a bottle propped in the mouth (feeding). Two staff were present in the room attending to 7 other infants.This poses a potential risk to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: 11/05/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/05/2021


LIC809 (FAS) - (06/04)
Page: 2 of 2