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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701396
Report Date: 10/04/2022
Date Signed: 10/04/2022 01:50:38 PM

Document Has Been Signed on 10/04/2022 01:50 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:KINDERHOUSE MONTESSORI SCHOOLFACILITY NUMBER:
376701396
ADMINISTRATOR:ALEXANDRA POPFACILITY TYPE:
850
ADDRESS:6540 FLANDERS DRIVETELEPHONE:
(858) 550-0097
CITY:SAN DIEGOSTATE: CAZIP CODE:
92121
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 69DATE:
10/04/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:36 PM
MET WITH:TIME COMPLETED:
01:50 PM
NARRATIVE
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On 10/4/22 at 1:36 PM, Licensing Program Analyst (LPA) Annette Sutherland conducted an unannounced site inspection for the purpose of follow-up on an incident that occurred on 09/27/2022 at 11:46 AM. A 4-year-old child was left on the school playground without adult supervision. Two teachers were in charge of 15 children playing on the playground. The child was found by one of those staff members in charge 2-3 minutes later.

The following ratios were observed today: there were 69 children supervised by 11 staff members in seven classrooms. Children were napping on cots. All staff members have the required background clearances.

The incident was self reported to Community Care Licensing by the facility with a written incident report that was received within the seven days requirement on 09/27/2022.

The child was brought back into hus classroom approximately 2-3 minutes. Director stated that she terminated the 2 staff members involved. Director will retrain all staff members on how to properly account for children in their care and how to always match names on their rosters with the faces of the children before transitioning from one environment to the other.

Director stated that the two staff members that were in charge of the children were terminated on 09/27/2022 as a result of the incident.

See LIC 809D for type B deficiency cited today:

An exit interview was conducted and appeal rights were provided to the facility representative. Notice of site visit was provided and it shall remain posted at the facility for 30 days.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2022
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 10/04/2022 01:50 PM - It Cannot Be Edited


Created By: Annette Sutherland On 10/04/2022 at 11:37 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: KINDERHOUSE MONTESSORI SCHOOL
FACILITY NUMBER: 376701396

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/04/2022
Section Cited
CCR
101229(a)(1)

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101229(a)(1) Responsibility for Providing Care and Supervision: (a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement was not met as evidenced by:
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The director stated that she conducted a staff meeting to train all staff on proper supervision and transitions. The director will provide LPA with a copy of the meeting agenda and staff sign in sheets or staff acknowledgements via email (Annette.Sutherland@dss.ca.gov) by POC due date of 10/17/22.
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Based on information received by Director, Child #1 was left behind in the playground, without supervision, for a period of approximately 2-3 minutes before being found by staff member and taken back inside. 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:Monica Cuddy
LICENSING EVALUATOR NAME:Annette Sutherland
LICENSING EVALUATOR SIGNATURE:
DATE: 10/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2022


LIC809 (FAS) - (06/04)
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