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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093616872
Report Date: 08/14/2024
Date Signed: 08/14/2024 02:48:22 PM

Document Has Been Signed on 08/14/2024 02:48 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MADRONE MONTESSORI SCHOOL, LLCFACILITY NUMBER:
093616872
ADMINISTRATOR/
DIRECTOR:		CAMPBELL, KRISTAFACILITY TYPE:
850
ADDRESS:5001 WINDPLAY DRIVE #1TELEPHONE:
(530) 676-4110
CITY:EL DORADO HILLSSTATE: CAZIP CODE:
95762
CAPACITY: 74TOTAL ENROLLED CHILDREN: 74CENSUS: DATE:
08/14/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:05 PM
MET WITH:Krista CampbellTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
NARRATIVE
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On August 14, 2024, Licensing Program Analyst (LPA) Soleil Marx, met with Facility Representative, Krista Campbell, for an unannounced annual inspection. LPA observed a census of 39 preschool children being supervised by five staff and 6 toddlers being supervised by one staff in the toddler component. Facility Representative was reminded never to exceed the conditions, limitations and capacity specified on the license. All individuals subject to criminal record review have obtained clearance. Facility hours of operation are Monday through Friday, 7:00 AM to 6:00 PM.

LPAs inspected all activity and classroom spaces, restrooms, food service, and outdoor play areas. Hazardous items were inaccessible to children. The floors appeared clean throughout the facility. Furniture and equipment were in safe, operable condition. Outdoor activity space and equipment were in good repair and free of loose or sharp parts. LPAs observed adequate cushioning in areas underneath climbing equipment and adequate shade provided. Toileting facilities were in safe, sanitary, and operating condition. Food preparation space was hygienic, and all food protected against contamination. AM/PM snack is parent provided and children bring individual lunch from home. Trash bins have tight-fitting lids. LPAs observed medications were stored in a central location and an ample amount of first aid supplies available. LPAs observed a functional carbon monoxide detector within the facility. LPAs observed facility uses electronic sign in/sign out system. There are no bodies of water on the premises.

LPAs reviewed facility records including child's records, personnel records, administrative records, and documents to be posted. LPAs reviewed a sample of children’s files and observed that each child's file contained the required licensing documentation. LPAs reviewed records for all staff. At least one staff member present today has current Pediatric CPR and First Aid certification. All staff currently employed with the facility have: a criminal record clearance, a health screening report, immunization records, current AB1207 Mandated Reporter Training, and documentation of their educational background, training, and/or experience. LPAs observed a children's roster and fire drill log within the facility. LPAs observed all required licensing documents were posted and visible to authorized representatives. (page 1)

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE: DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/14/2024
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 08/14/2024 02:48 PM - It Cannot Be Edited


Created By: Soleil Marx On 08/14/2024 at 01:56 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: MADRONE MONTESSORI SCHOOL, LLC
FACILITY NUMBER: 093616872

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101239.1(d)
(d) Napping equipment shall be arranged so that each child has access to a walkway without having to walk on or over the cots or mats of other children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above by not leaving space between nap mats, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/21/2024
Plan of Correction
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Facility Representative (FR) will extend the area utilized for nap time so there is more space to spread out. FR will submit proof of nap mat placement to LPA Marx by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Natalie Dunaway
LICENSING EVALUATOR NAME:Soleil Marx
LICENSING EVALUATOR SIGNATURE:
DATE: 08/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/14/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/14/2024 02:48 PM - It Cannot Be Edited


Created By: Soleil Marx On 08/14/2024 at 02:00 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: MADRONE MONTESSORI SCHOOL, LLC
FACILITY NUMBER: 093616872

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101216.4(a)(2)
101216.4 PRESCHOOL PROGRAM WITH TODDLER COMPONENT
(a) Licensees serving preschool-age children may create a special program component for children who are between 18 months and 36 months of age....(2) The toddler program shall be conducted in areas physically separate from those used by older or younger children. Space planning and usage for the toddler component shall be governed by the provisions of Section 101438.3....
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above by commingling the toddler component with the preschool license during nap, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/15/2024
Plan of Correction
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Facility Representative stated they will create two seperate nap rooms/areas that are physically seperate so the toddler option is not combined with the preschool license during nap time. LPA will conduct return visit to ensure compliance.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Natalie Dunaway
LICENSING EVALUATOR NAME:Soleil Marx
LICENSING EVALUATOR SIGNATURE:
DATE: 08/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/14/2024


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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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MADRONE MONTESSORI SCHOOL, LLC
FACILITY NUMBER: 093616872
VISIT DATE: 08/14/2024
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LPA observed sleep checks conducted and documented every 15 minutes for all children under two.

LPA discussed the safe sleep regulations with licensee facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed facility representative 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.

Facility Representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code 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.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, 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). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES.

LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Facility representative 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.

(page 2)

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024
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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MADRONE MONTESSORI SCHOOL, LLC
FACILITY NUMBER: 093616872
VISIT DATE: 08/14/2024
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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.

Based on Today’s inspection, two Title 22 deficiencies are being cited on 809-D.



Licensee was informed that this report dated 08/14/2024 documents one Type A citation which shall be posted for 30 consecutive days. The Licensee shall also provide a copy of this licensing report to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. Licensee has been provided with appeal rights.

Exit interview conducted and report was reviewed with the Facility Representative, Krista Campbell. A notice of site visit was given and must remain posted for 30 days. Appeal rights were provided.

(page 4) (continued on 809-D)

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Soleil Marx
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024
LIC809 (FAS) - (06/04)
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