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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566211104
Report Date: 08/28/2025
Date Signed: 08/28/2025 04:11:36 PM

Document Has Been Signed on 08/28/2025 04:11 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:SIMI VALLEY MONTESSORI SCHOOLFACILITY NUMBER:
566211104
ADMINISTRATOR/
DIRECTOR:		GRACE PEIRISFACILITY TYPE:
830
ADDRESS:1776 ERRINGER ROAD #104TELEPHONE:
(805) 584-7900
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 10DATE:
08/28/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:35 PM
MET WITH:Grace PeirisTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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On August 28, 2025 at 02:35 AM Licensing Program Analysts (LPAs) Laura Carone and Brian Fung made an unannounced visit to conduct an Case Management-Deficiencies inspection. LPAs met with Director, Grace Peiris and explained the purpose of the inspection. LPAs and Director toured the interior and exterior of the center. There were 10 children with 3 staff at the time of the inspection.

On August 5, 2025, an Annual Random inspection was conducted. LPAs issued citations for deficiencies observed. All deficiencies have been corrected:

CCR 101430(a)(3)(A) Staff shall place infants up to 12-months of age on their backs for sleeping.-A staff meeting was conducted to discuss infants need to be placed on their backs when playing in crib
CCR 101430(a)(3)(C) An infant shall not be swaddled while in care.-LPAs did not observe any sleep sacks in the infant areas.
CCR 101416.5(b) There shall be a ratio of one teacher for every four infants in attendance. During today's inspection LPAs observed 3 teachers with 10 infants.
CCR 101439.1(f)(1)(A) There shall not be anything attached to the pacifier. No items observed on pacifiers.
CCR101239(f)(1) moveable bins, shall have a tight fitting cover that is kept on; LPAs observed lids on trash bins.
CCR 101439(h)(4) Infant changing tables shall: (4) While in use, be placed within arm's reach of a sink.-Changing table is now within arms reach of a sink.

CONTINUED ON LIC809C
NAME OF LICENSING PROGRAM MANAGER: Susana Martinez
NAME OF LICENSING PROGRAM ANALYST: Laura Carone
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: SIMI VALLEY MONTESSORI SCHOOL
FACILITY NUMBER: 566211104
VISIT DATE: 08/28/2025
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CCR 101238(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. Perfume spray bottle has been removed from classroom.
CCR 101439(e)(5) (5) No infant shall be left unattended while in a high chair. LPAs observed teachers with children while in the high chairs.
CCR 101216.1(b)(1) teacher shall have completed, with passing grades, at least six postsecondary semester or equivalent quarter units of the education requirement-Teacher Assistant is now enrolled in Child Development course at Moorpark College for the fall semester.
HSC 1596.8662(b)(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-Teachers completed Mandated Reporter Training on .
HSC 1596.871(c)(1)(A) Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(-Teacher fingerprints were associated to facility roster on 08/16/2025.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director, Grace Peiris.
NAME OF LICENSING PROGRAM MANAGER: Susana Martinez
NAME OF LICENSING PROGRAM ANALYST: Laura Carone
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
LIC809 (FAS) - (06/04)
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