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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566211104
Report Date: 04/15/2026
Date Signed: 04/15/2026 03:36:05 PM

Document Has Been Signed on 04/15/2026 03:36 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: 9DATE:
04/15/2026
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:59 AM
MET WITH:Grace PeirisTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On 4/15/26, at 8:59AM, Licensing Program Analyst (LPA) Seena Parsapour conducted an unannounced Annual/Required inspection of the abovementioned Child Care Center (CCC). LPA met with Director Grace Peiris and explained the nature & purpose of the inspection. LPA, in the company of Director, toured the interior and exterior of the CCC. The CCC operates Monday-Friday from 7:30am-5:30pm. The facility uses one classroom (denoted Classroom 1) divided into two (2) sections for infant care purposes. At the time of the inspection, LPA observed nine (9) infants under the care & supervision of four (4) staff members, including Director (cleared and associated).
The CCC is clean and orderly. LPA observed required licensing forms and documents posted near the entrance of the CCC. At 9:01AM, by record review and upon interviewing Director, LPA determined that the LIC 610 - Emergency Disaster Plan for Child Care Centers - was incomplete, as two (2) temporary relocation sites & respective addresses were not listed. LPA discussed with Director who understood that this document must be updated to reflect two (2) appropriate temporary relocation sites complete with addresses listed. A Technical Violation (TV) was issued. LPA observed the daily routine/schedule posted prominently in the classroom. LPA notes the CCC maintains paper Sign In/Out forms on file. LPA notes the forms contain the arrival and departure times of infants in care and well as the signatures of the infants' authorized representatives. At 9:31AM, during record review of the Sign In/Out logs, LPA discovered that on 4/09/2026 and 4/10/2026, historical records indicate Child #08 (C8) & C3, respectively, were not signed out as the "time out" and "Print name" columns were left blank. LPA discussed the requirement for sign in/out logs to be properly completed for all children in care, during each day of operation. Director confirmed their understanding of this requirement and advised LPA they will discuss the requirement with parents of children enrolled. A Technical Violation (TV) is being issued. (Cont. 809-C, Page 2)
NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Seena Parsapour
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/15/2026
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: 04/15/2026
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The classrooms have age-appropriate equipment and furnishings available to infants in care. At 10:56AM, LPA observed Child #01 (C1), who was accompanied by their therapist, to be playing inside Classroom 1, which - per interview with Director and record review - is the classroom designated for infant-aged children. LPA discussed the commingling issue with Director, and advised Director that C1 must be relocated to a classroom designated for the use of preschool-aged children, and observed on-site correction as C1 and their therapist relocated to Classroom 2. LPA observed disinfectants, cleaning solutions, sharps, and other hazardous items in the classroom stored in areas inaccessible to infants in care. Medications in the CCC are stored in an area inaccessible to infants, and a refrigerator in the kitchen area is used to store food for infants in care. Milk, food, and snacks are provided by the parents of infants in care, and are stored in individually labeled containers for each infant, inside a refrigerator. At 1:14PM, by interview with Director, LPA confirmed that the CCC does not maintain supplemental food on site for infants. Director advised LPA that parents are instructed to bring their own food for infants in care. LPA advised Director of the requirement that food be available for infants in care in the event that the infant's authorized representative forgets to bring it, and confirmed their understanding. LPA observed a first aid kit available in the CCC. LPA observed a smoke detector, fire suppression system, and carbon monoxide detector in the CCC, but the detectors were not tested as it was nap time for infants in care during the inspection. During the inspection, LPA observed a mattress that was not in good repair as the foam substrate was exposed through a tear in the synthetic cover material, and Director advised the mattress is being set aside and is not being used for infants in care. Director advised LPA that the mattress will be discarded and replaced. A Technical Advisory (TA) is being issued.

A changing station for infants in care was observed within arm’s reach of a sink, and was found in safe, sanitary, and operating condition. LPA observed feeding, sleeping, and changing logs being completed & maintained on file. The CCC uses filtered drinking water for infants at the facility. LPA notes the outdoor play area is fully enclosed. LPA observed the entry/exit points to be secured. LPA observed age-appropriate toys & play equipment in the outdoor play area. The play equipment is free of sharp, loose or pointed objects. LPA notes that shade is available in the outdoor play area. LPA reminded Director that outdoor play equipment and furnishings should be replaced when such items begin to degrade or are no longer in good repair. LPA notes the outdoor play area is not used for infants in care, but rather, for toddlers and preschool aged children. No bodies of water were observed on site. (Cont. 809-C, Page 3)
NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Seena Parsapour
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026
LIC809 (FAS) - (06/04)
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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: 04/15/2026
NARRATIVE
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LPA reviewed children’s records for the nine (9) infants present at the time of the inspection. At 12:43PM, by interview with Director and record review, LPA determined that the LIC701 was not on file for Child #03 (C3). Director advised LPA that they will follow up with the parent of C3 to obtain this completed document. The infants’ records reviewed were found otherwise to be current & complete. LPA reviewed staff records for the four (4) staff members present at the time the inspection began, which were found to be current & complete as well, including AB1207 compliant Mandated Reporter Training certification, and Pediatric 1st Aid & CPR Training Certification, among other required documents. LPA notes the most recent fire/disaster drill occurred on 3/19/2026. The CCC maintains a current facility roster listing infants in care. No firearms or ammunition are stored on site.
This facility does not currently provide Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed infants’, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.
CCCs constructed before January 1, 2010, are required to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP). At 10:31am, by interview with Director, LPA determined that the lead testing document was not on file. LPA notes that during the 8/05/2025 annual/random inspection, the lead testing document was on file and reviewed by LPAs Brian Fung & Laura Carone. LPA discussed with Director the requirement to maintain this document on file at the facility for review. Director confirmed their understanding of this requirement. LPA observed filtered drinking water available for infants in care, by way of two (2) Brita brand filtered water pitchers.

(Cont. 809-C, Page 4)
NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Seena Parsapour
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026
LIC809 (FAS) - (06/04)
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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: 04/15/2026
NARRATIVE
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LPA discussed the safe sleep regulations with Director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
Director was reminded that all adults 18 and over, including employees and volunteers, except as specified in HSC section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.
During today's inspection, four (4) Type B deficiencies are being cited under Title 22 of the California Code of Regulations & Health and Safety Codes (See LIC809-D). Director was provided a copy of their Appeal Rights (LIC 9058) and their signature on this form acknowledges receipt of these rights.
A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Director Grace Peiris.
NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Seena Parsapour
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/15/2026 03:36 PM - It Cannot Be Edited


Created By: Seena Parsapour On 04/15/2026 at 02:30 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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: SIMI VALLEY MONTESSORI SCHOOL
FACILITY NUMBER: 566211104

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/15/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in that the lead testing certificate was not on file or available for review during the inspection, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/24/2026
Plan of Correction
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Licensee shall submit to the Department (seena.parsapour@dss.ca.gov) a current lead testing certificate, as well as a written statement explaining how they plan on ensuring compliance with this regulation moving forward, no later than Friday, 4/24/2026.
Type B
Section Cited
CCR
101438.3(b)
Indoor Activity Space For Infants
(b) Indoor activity space for infants shall be physically separate from space used by children in the child care center and school-age child care center components.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in that a preschool-aged child, C1, who was accompanied by their therapist, was playing in an infant-designated classroom, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/24/2026
Plan of Correction
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Licensee shall submit to the Department (seena.parsapour@dss.ca.gov) a written statement explaining how they plan on ensuring compliance with this regulation moving forward, no later than Friday, 4/24/2026. LPA observed on-site correction as C1 and their therapist relocated to Classroom 2.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Maria Mueller
NAME OF LICENSING PROGRAM MANAGER:
Seena Parsapour
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/15/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/15/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/15/2026 03:36 PM - It Cannot Be Edited


Created By: Seena Parsapour On 04/15/2026 at 02:30 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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: SIMI VALLEY MONTESSORI SCHOOL
FACILITY NUMBER: 566211104

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/15/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101220(a)
Child's Medical Assessments
(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in that the LIC701 was not on file for Child #03 (C3), which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/24/2026
Plan of Correction
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Licensee shall submit to the Department (seena.parsapour@dss.ca.gov) the completed LIC701 for C3, as well as a written statement explaining how they plan on ensuring compliance with this regulation moving forward, no later than Friday, 4/24/2026.
Type B
Section Cited
CCR
101427(c)(2)
Infant Care Food Services
(2) The infant care center shall have appropriate food available for the infant.

This requirement is not met as evidenced by:
Deficient Practice Statement
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3
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Based on interview, the licensee did not comply with the section cited above in that the CCC does not maintain supplemental food on site for infants, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/24/2026
Plan of Correction
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3
4
Licensee shall submit to the Department (seena.parsapour@dss.ca.gov) a written statement explaining how they plan on ensuring compliance with this regulation moving forward, no later than Friday, 4/24/2026.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Maria Mueller
NAME OF LICENSING PROGRAM MANAGER:
Seena Parsapour
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/15/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/15/2026


LIC809 (FAS) - (06/04)
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