573603061-10-15-2021-53-CC-MPRE-C7TV3T-20211015160517

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 573603061
Report Date: 10/15/2021
Date Signed: 10/15/2021 04:05:26 PM

Document Has Been Signed on 10/15/2021 04:05 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME:	MONTESSORI COUNTRY DAY II		FACILITY NUMBER:	573603061
ADMINISTRATOR:	HANNAGAN, LORI		FACILITY TYPE:	850
ADDRESS:	2802 SPAFFORD		TELEPHONE:	(530) 753-5225
CITY:	DAVIS	STATE: CA	ZIP CODE:	95616
CAPACITY: 82	TOTAL ENROLLED CHILDREN: 42	CENSUS: 33	DATE:	10/15/2021
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:27 AM
MET WITH:	Debbie Robertson		TIME COMPLETED:	03:49 PM

NARRATIVE

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On 10/15/2021 at 9:27am Licensing Program Analyst (LPA) Morgan Pringle met with Director Debbie Robertson for an Unannounced Annual Inspection. Three (3) classrooms were toured for a health and safety inspection. The facility has a toddler option with their preschool license. Thirty-one (31) preschool children and two (2) toddlers were present during the inspection. Nine (9) staff members were present during the inspection. The facility operates from 8:00am – 5:00pm.

The facility has age appropriate materials in all classrooms that are observed to be clean and in good condition. The outdoor spaces have ample shade for the children and age appropriate materials. All toxins, cleaning products, medications, and hazardous materials were observed to be in inaccessible areas. All sinks and toilets were observed to be clean and in proper working order. The counters were observed to be clean and free from hazards. All napping equipment and changing tables are clean and properly stored in each room. LPA did not observe any harmful or unattended bodies of water in or around the facility. Facility also does not currently have a working carbon monoxide detector (see LIC9102TV).

The facility is operating within its licensed capacity and is in ratio. All proper postings are made visible in the entry way of the facility. The fire/disaster drill log was complete with the last drill logged 9/7/2021. Due to the Covid-19 pandemic the facility has been using an electronic sign in/out. LPA informed Director about how to get a waiver. A physical census of the children and staff was taken and cross referenced with the sign-in and out log. LPA obtained a sample of the children’s files and the staff files. Through record review, LPA observed C1 was not properly signed in (see LIC809-D).

Continued on 809-C

SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: MONTESSORI COUNTRY DAY II	FACILITY NUMBER: 573603061
	VISIT DATE: 10/15/2021

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Director was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Personnel Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. Director was reminded that California Law requires all facilities to report unusual incidents or injuries to children in care, to child's parents, and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or email. LPA informed Director that all forms can be downloaded at www.ccld.ca.gov. Director was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

Director was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Director Debbie Robertson.

SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/15/2021 04:05 PM - It Cannot Be Edited

Created By: Morgan Pringle On 10/15/2021 at 03:11 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
, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: MONTESSORI COUNTRY DAY II	FACILITY NUMBER: 573603061
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/15/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Deficiency Dismissed

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
1 2 3 4	Based on record review the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/15/2021
	Plan of Correction
1 2 3 4	Deficiency was cleared during inspection. Director found Physicans report.

Deficiency Dismissed

Type B

Section Cited

CCR

101229.1(b)

Sign In and Sign Out

(b) The person who brings the child to, and removes the child from, the center shall sign the child in/out. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on the licensee did not comply with the section cited above of which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/19/2021
	Plan of Correction
1 2 3 4	Director will ensure child is properly signed in and out.

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:

Justin L Denton

LICENSING EVALUATOR NAME:

Morgan Pringle

LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2021

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021

LIC809 (FAS) - (06/04)

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