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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750091
Report Date: 03/26/2021
Date Signed: 03/26/2021 02:30:32 PM

Document Has Been Signed on 03/26/2021 02:30 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 PLUM CANYONFACILITY NUMBER:
197750091
ADMINISTRATOR:AARON BAILEYFACILITY TYPE:
830
ADDRESS:19141 SKYLINE RANCH RDTELEPHONE:
(949) 354-2259
CITY:SANTA CLARITASTATE: CAZIP CODE:
91350
CAPACITY: 42TOTAL ENROLLED CHILDREN: 0CENSUS: 35DATE:
03/26/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Martha Georgie, Head of SchoolTIME COMPLETED:
02:45 PM
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On 03/26/2021, Licensing Program Analyst (LPA) Monique Ayala conducted a case management inspection to follow up on an Unusual Incident reported to the department by telephone on 03/16/2021; this incident was reported timely. LPA spoke with Head of School. Due to COVID-19 Emergency Response this inspection was conducted virtually. LPA virtually toured the facility and took a census of the children. Upon arrival, there were 26 toddlers and 9 infants with 15 staff present today at the facility.

Description of the incident: An incident on 03/16/2021, C1 bumped heads with C2 and sustained a bloody nose. S1 and S2 provided first aid care to C1 and notified Head of School. Head of School informed C1's parents and C1 was picked up by parents within 15 minutes of incident and was taken to the doctor. The family notified the facility as soon as doctor’s visit was over. The doctor stated C1 was checked for a broken nose and concussion, both came back negative. C1 resumed back to her normal self and was not in any pain.

During this inspection, LPA interviewed staff and obtained a copy of the facility roster. LPA received pictures from Head of School where the incident took place.

No deficiencies were observed at the time of the visit.

An exit interview was conducted and a copy of this report was provided along with Notice of Site Visit via email on 03/26/2021.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE: DATE: 03/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/26/2021
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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