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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750077
Report Date: 07/21/2022
Date Signed: 07/21/2022 05:46:44 PM

Document Has Been Signed on 07/21/2022 05:46 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:GUIDEPOST MONTESSORI AT COPPER HILLFACILITY NUMBER:
197750077
ADMINISTRATOR:ERIN TRICEFACILITY TYPE:
850
ADDRESS:25135 RYE CANYON LOOPTELEPHONE:
(747) 800-4150
CITY:SANTA CLARITASTATE: CAZIP CODE:
91355
CAPACITY: 126TOTAL ENROLLED CHILDREN: 126CENSUS: 35DATE:
07/21/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:59 PM
MET WITH:Gina Castello, DirectorTIME COMPLETED:
06:00 PM
NARRATIVE
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On 07/21/2022, Licensing Program Analyst (LPA) Liana Stepanyan and Licensing Program Manager (LPM) Mariela Ramon met with Gina Castello who guided LPA and LPM on a tour of the facility. Upon arrival, LPA and LPM observed 35 children under care and supervision with 9 staff members.

The purpose of this visit was to conduct a follow up on Case Management inspection regarding an unusual incident that occured on 07/08/22 and was reported to the department via telephone the same date and a written Unusual Incident Report was received at the Department on 07/14/2022.

The unusual incident report indicated that on 07/08/22 child #1 was climbing the play structure leaned forward and fell off the structure hitting her face on the play ground resulting in 2 scrapes on the right side of her face and another scrape on the groin area.

During this case management inspection interviews were conducted with children and staff.

Interviews revealed child #1 fell from the play structure and landed on the wood chips resulting in child #1 sustaining a scratch right above the eyebrow, another scratch on the cheekbone and 2 scratches on the groin area. Staff #1 and #2 were providing supervision to a group of children (no more than 24 children). Staff #1 and 2 were not aware how child #1 fell off the play structure.

See Facility Evaluation Report LIC 809C for additional information.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Liana Stepanyan
LICENSING EVALUATOR SIGNATURE: DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: GUIDEPOST MONTESSORI AT COPPER HILL
FACILITY NUMBER: 197750077
VISIT DATE: 07/21/2022
NARRATIVE
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Child #1's mother was notified immediately, first aid measures were taken.

Child #1's mother contacted child's doctor who determined child #1's injuries were minor and did not require medical attention.

As a result of lack of supervision the facility was cited a Type B deficiency. See Facility Evaluation Report LIC 809D for deficiency cited.

An exit interview was conducted, a copy of this report was provided along with the appeal rights.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Liana Stepanyan
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022
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Document Has Been Signed on 07/21/2022 05:46 PM - It Cannot Be Edited


Created By: Liana Stepanyan On 07/21/2022 at 05:17 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
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: GUIDEPOST MONTESSORI AT COPPER HILL
FACILITY NUMBER: 197750077

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/04/2022
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision: No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time. This requirement was not met as evidence by: Based on interviews conducted it was determined that on 07/08/22, child #1 fell from the play structure and landed on wood chips resulting in child #1 sustaining
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Director shall submit a written statement to the Department no later than 8/4/22 indicating what steps will be taken to prevent this type of incident from re-occurring.
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scratches one on right above the eyebrow area, another one on the cheekbone and 2 scratches on the groin area. Staff #1 and #2 were providing supervision to a group of children (no more than 24 children). Staff #1 and 2 were not aware how child #1 fell off the play structure. This is a Type B deficiency that poses potential threat to health and safety of 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:Mariela Ramon
LICENSING EVALUATOR NAME:Liana Stepanyan
LICENSING EVALUATOR SIGNATURE:
DATE: 07/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2022


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