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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197492864
Report Date: 02/09/2022
Date Signed: 02/09/2022 03:41:08 PM

Document Has Been Signed on 02/09/2022 03:41 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:BEGINNING MONTESSORI CHILDREN'S HOUSE INC, THEFACILITY NUMBER:
197492864
ADMINISTRATOR:IPALAWATTE, SUNETHRAFACILITY TYPE:
830
ADDRESS:7475 FALLBROOKE AVETELEPHONE:
(818) 992-5341
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY: 10TOTAL ENROLLED CHILDREN: 10CENSUS: 6DATE:
02/09/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:13 PM
MET WITH:Sunethra IpalawatteTIME COMPLETED:
03:55 PM
NARRATIVE
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On 02/09/2022 L Thompson observed the following deficiencies during a complaint investigation.
  • Children records were incomplete
  • Staff records were missing documentation
  • Director was unable to provide an Individual Sleep Plan
  • Sign in and out sheet were completed by staff members

(see 809D)

Licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be obtained as proof of parent’s receipt. LPA instructed licensee to post LIC 9213- Notice of Site Visit. Notice of Site Visit must be posted for 30 days. Failure to post required visit reports for 30 consecutive days will result in immediate civil penalty assessment of $100
SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 02/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/09/2022
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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Document Has Been Signed on 02/09/2022 03:41 PM - It Cannot Be Edited


Created By: Laticia S Thompson On 02/09/2022 at 02:17 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BEGINNING MONTESSORI CHILDREN'S HOUSE INC, THE
FACILITY NUMBER: 197492864

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/09/2022
Section Cited
CCR
101430(a)(1)

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101430 Infant Care Activities(a)(1)The infant care center shall develop, maintain and implement a written plan to ensure the provision of indoor and outdoor activities designed to meet the needs of infants This requirement was not met as evidenced by
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Director will delvelop an indoor and outdoor activity plan by 02/14/2022
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Based on LPA request to review records and Director was unable to provide a written plan of indoor and outdoor activities.This poses and potential Health and Safty risk to children in care.
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Type B
02/09/2022
Section Cited
CCR101430(3)(A)(4)

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101430 Infant Care Activities(3)(A)(4)Infants with an Individual Infant Sleeping Plan [LIC 9227.... that have Section C of the form completed and signed by an authorized representative shall be placed on their back when first laid down to sleep.... In the event....alternative position. This requirement was not met as evidenced by
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Director will completed LiC9227 by 02/14/2022
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Based on LPA's request to review records and director provided a blank LIC 9227 this poses and potential Health and Safty risk to children in care.
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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:Peter Flores
LICENSING EVALUATOR NAME:Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 02/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/09/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/09/2022 03:41 PM - It Cannot Be Edited


Created By: Laticia S Thompson On 02/09/2022 at 02:49 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BEGINNING MONTESSORI CHILDREN'S HOUSE INC, THE
FACILITY NUMBER: 197492864

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/09/2022
Section Cited
CCR
101439.1(f)

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101439.1 Infant Care Center Sleeping Equipment Cribs (f)shall be free from all loose articles and objects, including blankets and pillows. This requirement was not met as evidenced by
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Director will ensure that all cribs will free of any articles or objeects. Director will inform parents blankets are not allowed to be left at the facility.
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Based on LPA"s observation of blankets hanging along side the crib and interviews with staff stating parents request use of blankets in the facility during napping. This poses and potential Health and Safety risk to children in care.
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Type B
02/09/2022
Section Cited
CCR101221(a)

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101221 Child's Records (a) A separate, complete and current record for each child is maintained in the child care center This requirement was not met as evidenced by
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Director will updated childrens record based on the forms required on form LIC 311A by 02/19/2022
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Based on LPA"s record review, children records were missing documents.This requirement was not met as evidenced by
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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:Peter Flores
LICENSING EVALUATOR NAME:Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 02/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/09/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/09/2022 03:41 PM - It Cannot Be Edited


Created By: Laticia S Thompson On 02/09/2022 at 03:02 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BEGINNING MONTESSORI CHILDREN'S HOUSE INC, THE
FACILITY NUMBER: 197492864

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/09/2022
Section Cited
CCR
101217(a)

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101217 Personnel Record(a)(1-14)) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information.....This requirement was not met as evidenced by
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Director will provide LPA with a copy of complete records of Staff#1 and Staff2 by 02/19/2021
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Based on LPA's review of staff records LPA observed several documents missing and incomplete.This poses and potential Health and Safety risk to children in care
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Type B
02/02/2022
Section Cited
CCR101629.1(b)

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101629.1 Sign In and Sign Out (b)t the licensee shall require that each child be signed in and out by his/her authorized representative. This requirement was not met as evidenced by
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Director will insure that parents or representative will sign children in and out begining immediately.
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Based on LPA's observation and interview that teachers were signing infants in and outhis poses and potential Health and Safety risk to children in care
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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:Peter Flores
LICENSING EVALUATOR NAME:Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 02/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/09/2022


LIC809 (FAS) - (06/04)
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