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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197417396
Report Date: 10/04/2021
Date Signed: 10/04/2021 05:04:16 PM

Document Has Been Signed on 10/04/2021 05:04 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:MONTESSORI OF VALENCIAFACILITY NUMBER:
197417396
ADMINISTRATOR:ERIN JOHNSONFACILITY TYPE:
850
ADDRESS:24925 ANZA DRIVETELEPHONE:
(661) 257-4161
CITY:VALENCIASTATE: CAZIP CODE:
91355
CAPACITY: 138TOTAL ENROLLED CHILDREN: 0CENSUS: 26DATE:
10/04/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:49 PM
MET WITH:Lisa Walker, Lead teacherTIME COMPLETED:
05:10 PM
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Mariela Ramon, Licensing Program Manager (LPM), Lady King-Lewis and Liana Stepanyan, Licensing Program Analysts (LPAs) conducted a Case Management Inspection to the facility for the purpose of delivering an Immediate Exclusion Order for staff Stephanie Roberts. Upon arrival LPM and LPAs met with Lisa Walker lead teacher. LPM and LPAs observed 26 children with 9 providing care and supervision. During this inspection, Stephanie Roberts was not present.

The California Department of Social Services (CDSS) has determined that Stephanie Roberts continued or future contact with clients or presence in any community care facility, child day care facility, residential care facility for the elderly, or any other facility licensed by CDSS, constitutes a threat to the health, welfare or safety of the clients in care.

Upon receipt of the immediate exclusion order, Stephanie Roberts, must remove herself from any contact with clients and not be physically present in any facility. This action is final until Stephanie Roberts is notified otherwise, in writing by CDSS.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Lady King
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2021
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MONTESSORI OF VALENCIA
FACILITY NUMBER: 197417396
VISIT DATE: 10/04/2021
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The order to immediately exclude Stephanie Roberts was discussed in detail with Lisa Walker is aware that Stephanie Roberts must not be physically present in the facility nor can she have contact with children in care. Lisa Walker acknowledges the receipt of the Immediate Exclusion Order served today.

An exit interview was conducted with Lisa Walker and a copy of this report was provided along with the appeal rights.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Lady King
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2021
LIC809 (FAS) - (06/04)
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