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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197417032
Report Date: 08/04/2022
Date Signed: 08/04/2022 12:23:15 PM

Document Has Been Signed on 08/04/2022 12:23 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:MONTESSORI OF CHATSWORTHFACILITY NUMBER:
197417032
ADMINISTRATOR:ERBE, ANNAFACILITY TYPE:
830
ADDRESS:10616 ANDORA AVENUETELEPHONE:
(818) 709-2980
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY: 16TOTAL ENROLLED CHILDREN: 12CENSUS: 9DATE:
08/04/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:17 AM
MET WITH:ERBE, ANNA - DirectorTIME COMPLETED:
12:40 PM
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On 08/04/2022 Licensing Program Analyst (LPA), Suzette Ornelas conducted an unannounced Annual Required Inspection for the infant license. LPA met with Director, Anne Erbe, and toured the facility indoors and outdoors. Days and hours of operation are Monday through Friday 6:30a to 5:30p.

Center has preschool license (197407586) on the premises. LPA observed all required postings in a prominent area. A review of the sign in/out sheet was conducted to verify the current census of children. LPA observed 9 infants and 3 adults in the infant classroom. All children are under supervision, including visual supervision, of a teacher at all times. Capacity and limitations as specified on the license are being maintained. A walk through of the classroom area was conducted. LPA observed 1 infant classroom which included 1 sink and an infant changing table, a crib/nap area, and a door with direct access to the designated outdoor play yard. Infant changing table has a padded surface and is covered with washable vinyl or plastic and have raised sides at least three inches high. Floors in the facility are clean and safe. Furniture and equipment are in good condition, free of sharp, loose or pointed parts. Playground equipment is in safe condition and free of hazards. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. Areas around high climbing equipment, swings and slides have cushioning material to absorb falls. LPA advised director to ensure equipment is dusted off as needed. All kitchen, food preparation and storage areas are clean and safe. Per director, parents provide daily meals. Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is available both indoors and outdoors. The facility is free of flies, insects and rodents. The facility is equipped with a working carbon monoxide detector, smoke detector located inside of the classroom and a fire extinguisher (2A 10BC). There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible. No poisons were observed during the inspection, per director, pesticide service occurs monthly when no children are present.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE: DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/04/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MONTESSORI OF CHATSWORTH
FACILITY NUMBER: 197417032
VISIT DATE: 08/04/2022
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The facility has sufficient cribs, cots or mats for infant napping. Each crib, mat or cot is occupied by only one infant at time and cribs are kept free from all loose articles including blankets and pillows and there are no objects hanging above or attached to the crib. Infants are not swaddled while in care. Staff physically checks on sleeping infants every fifteen minutes; however, does not document fifteen minute checks or any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. LPA did observe sleep documentation which is taken daily and provided to parents. LPA provided director with infant safe sleep regulation, safe sleep log sample and safe sleep frequently asked questions to ensure regulations are followed. Individual Infant Sleeping Plan is not completed and in file for each infant up to 12 months of age. LPA provided licensee with a copy of the Infant Needs and Services Plan Regulation and a copy of the LIC 9227 form. Licensee will ensure parents complete the from and have it readily available in all children's files for the department to review. Infants up to 12 months of age are placed on their backs for sleeping or documentation for infants up to 12 months includes sleeping position if it is other than on their back. Staff-infant ratio requirements are being met while infants are sleeping. LPA reviewed a sample of children’s files and observed files were otherwise complete.

Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have received a criminal record clearance or exemption. At least one person trained in CPR and Pediatric First Aid is present when children are at the facility or at offsite activities. The name of the child care center director or fully-qualified teacher(s) designated to act in the director’s absence has been reported to the Department. LPA reviewed a sample of staff files and observed files were incomplete. LPA observed 2 staff missing documentation for MMR, Tdap immunization. Director will provide proof of documentation to LPA via email once documents are obtained. LPA provided director with a copy of the Disaster and Mass Casualty Plan regulation to ensure compliance.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MONTESSORI OF CHATSWORTH
FACILITY NUMBER: 197417032
VISIT DATE: 08/04/2022
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 LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022
LIC809 (FAS) - (06/04)
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