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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419166
Report Date: 01/05/2024
Date Signed: 01/05/2024 04:20:41 PM

Document Has Been Signed on 01/05/2024 04:20 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:MONTESSORI OF STEVENSON RANCHFACILITY NUMBER:
197419166
ADMINISTRATOR:ELLISON, DESIREEFACILITY TYPE:
850
ADDRESS:25940 THE OLD ROADTELEPHONE:
(661) 257-4161
CITY:STEVENSON RANCHSTATE: CAZIP CODE:
91381
CAPACITY: 188TOTAL ENROLLED CHILDREN: 188CENSUS: 91DATE:
01/05/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Assistant Director Soumya ShettyTIME COMPLETED:
05:00 PM
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On 01/05/2024, Licensing Program Analyst (LPA) Alemoh with the facility Assistant Director Soumya Shetty, for the One Year Required inspection for the preschool license in accordance with the facility sketch. A tour of the facility was conducted. Upon arrival LPA observed 91 preschool children and 12 teachers on the premises, along with the Directors. The hours of operation are 6:30AM - 6:30PM Monday - Friday. Incidental Medical Services (IMS) were discussed.

The facilities is utilizing 6 classrooms. All classrooms resemble the same layout.
There is no body of water on the premises.

Indoor/Children’s Area:
Child care center is clean, safe, sanitary and in good repair; all outdoor and indoor passageways, stair ways, incline, ramps, open porches and other areas of potential hazard are kept free of obstruction; floors of all rooms have a surface that is safe and clean, cleaning compounds inaccessible, poisons locked, furniture/equipment is good condition, free of flies, other insects, rodents; tables/chairs provided to meet children’s needs; all play equipment and materials used by children are age-appropriate, each child has an individual permanent or portable storage space (cubby, individually labelled with name) for his/her clothing, personal belongings and or bedding (stored separately). There is a working telephone.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE: DATE: 01/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/05/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MONTESSORI OF STEVENSON RANCH
FACILITY NUMBER: 197419166
VISIT DATE: 01/05/2024
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Trash cans for solid waste have tight fitting lids, drinking water is readily available indoors and outdoors (Drinking water is available inside the center in the form of filtered water to fill up each child's water bottle). LPA observed a sufficient quantity of mats available for napping preschool children. All materials and surfaces are toxic free are inaccessible, no fireplace. There is a working Carbon monoxide detector, smoke detector and Fire Extinguisher (3A40BC) in each classroom.

Staff/Personnel Records: Director (qualified) qualifications were verified, Designation of Responsibility observed, immunization's, TB clearance, health screening, criminal record statement, statement acknowledging suspected child abuse and mandated reporter were observed in file.

Facility Records: Roster, fire/disaster drill log last completed on 12/2023, CPR/First Aid, and mandated report training were reviewed.

Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty.The following were observed posted as required: facility license, Personal Rights (LIC613A), Parent’s Rights Poster (PUB 394L), emergency disaster plan, earthquake preparedness checklist.

Documents Provided and or Discussed: Forms and records to keep at the facility and IMS.

Advisory/Other: First Aid kit was observed with supplies (thermometer) readily available. CPR/First Aid expires on 06/24 . Mandated Reporter Training expires on 10/25.

Electrical outlets are inaccessible, recalled and or prohibited toys or sleep/play equipment were observed on the premises. There are no window cords accessible to children. Child nap on mats.

Sign in and out sheets were reviewed. The parent board was reviewed and has all of the required forms posted. Fire/earthquake drills current. Roster current.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2024
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MONTESSORI OF STEVENSON RANCH
FACILITY NUMBER: 197419166
VISIT DATE: 01/05/2024
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Restrooms: Each classroom has their own restroom. LPA inspected and observed 14 toilets and 14 sinks. LPA observed soap, toilet paper and paper towels readily available. Water temperature is appropriate. There is an isolation area for children who become ill while in care located near the front office, facility maintains a comfortable temperature at all times, first aid supplies (thermometer, bandages, scissors), sign in/out sheets (Electronically and manually) available and completed daily. No Smoking prohibited on the premises, daily inspection for illness, no prohibited child care items observed. Firearms/weapons are not allowed or stored on premises.

Napping: LPA observed children's personal sheets in each cubby. Mats used are maintained in good condition, wiped/cleaned/disinfected (daily) weekly or when soiled, no contact with other children bedding.

Outdoor: The facility has 2 playground area for the preschool children. The playground areas are separated by an iron fence. LPA observed an outside restroom to be clean and orderly. Outside play area is completely fenced. Outdoor play equipment was inspected for health, safety, good repair and age appropriateness. The area was observed to be free of debris, free from hazard, holes, broken items, debris, cushioning material underneath. There are areas for shade and rest. Preschool children have their own personal water bottles as well as disposable cups. LPA and observed a storage shed for outdoor play that was observed to be locked containing extra storage supplies as well as tables and chairs.

Teacher child ratios were observed and staff name recorded. Care and supervision was evaluated to determine if the basic needs of children are met and appropriate.

Health Related Services: Medications inaccessible to children; all prescription and non-prescription medications have child’s name and are dated; written consent and instruction from child’s representative, a plan to document and report to child’s representative when medication is administered to a child; IMS plan on file (if applicable).
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2024
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MONTESSORI OF STEVENSON RANCH
FACILITY NUMBER: 197419166
VISIT DATE: 01/05/2024
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Children are inspected for illnesses (wellness policy) as they arrive. A review of medication policy indicated that prescription medication is administered only with parent's written permission (licensing medication form- LIC9221 - also used). LPA advised the Director must administer medication, and document the dosage, date and time onto a log. Medication can be brought and taken home by the parent daily. Medication will be properly labeled and stored in its original container. Medications were observed in the director office in a locked box.

This facility provides Incidental Medical Services – IMS. Eppy pen was observed in front office in the locked box. 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/childquanda.htm

Food Service: The facility currently does not have a food program. Meals such as AM snack, PM snack and lunch is provided. LPA and inspected the kitchen where food is prepared and observed the food menu. Cleaning compounds are located at the top shelves making it inaccessible to children. The kitchen is off limits to preschool children.

Director advised of the requirement to report Unusual Incidents. Licensee informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department (email address on the website: www.unusualincidentreport@dss.ca.gov). A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above.


SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2024
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MONTESSORI OF STEVENSON RANCH
FACILITY NUMBER: 197419166
VISIT DATE: 01/05/2024
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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.

Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. Director shall permit the Department to inspect the family child care home, and to privately interview children or staff, to determine compliance with or to prevent violations of child care center or regulations, also enter and inspect any place providing personal care, supervision and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation.

A notice of site visit was given and must remain posted for 30 days.
Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
No deficiency. The On Duty Worker is available for questions at (661) 202-3318 Monday through Friday 8am-5pm.

Exit interview conducted and report was reviewed with Assistant Directors This report was read and provided to Assistant Directors along with her appeal rights and Notice of Site Visit.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2024
LIC809 (FAS) - (06/04)
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