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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750091
Report Date: 02/24/2022
Date Signed: 02/24/2022 04:56:05 PM

Document Has Been Signed on 02/24/2022 04:56 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: 42CENSUS: 31DATE:
02/24/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Gina Castello, Head of SchoolTIME COMPLETED:
05:00 PM
NARRATIVE
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On February 24, 2022, Licensing Program Analysts (LPAs) Monique Ayala and Liana Stepanyan conducted a case management inspection to follow up on an Unusual Incident reported to the department by telephone on 04/26/2021; this incident was not reported timely, the incident occurred on 04/21/2021. LPA was greeted by head of school who guided LPAs on a tour of the facility. Upon arrival, there were 31 children and 15 staff present today.

Description of the incident: An incident on 04/21/2021, Staff 1 (S1) was walking out of the classroom when child 1 (C1) was following the teacher out of the classroom. S1 closed the door quickly and did not see C1 fingers and the door closed on child's fingers. C1's fingers went under the door. S2 cleaned child's finger and applied ice. C1's mother was called and was advised to take child to seek medical attention. C1 was take to the doctor and did not receive stiches or glue on right pointer finger. (Staff and child names are listed on LIC859 and LIC857.)

During this inspection, LPA interviewed head of school, staff, parent of C1, obtained pictures of where the incident occurred, obtained images of injury and obtained a copy of the facility roster.

The information obtained during interviews conducted revealed that staff #1 was not in the area of the incident as she was outside of the classroom. S2 stated she was in the back of the classroom feeding infant 1 when the incident occurred. S2 stated that C1 was in the middle of the classroom when S1 was walking out and C1 ran faster than expected to the classroom door. S2 stated that she initially thought a sign that was posted near the door was what fell and cut C1's finger. After further investigation S2 stated that C1 was injured due to the door being closed on C1's right pointer finger.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE: DATE: 02/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/24/2022
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 02/24/2022 04:56 PM - It Cannot Be Edited


Created By: Monique Jessica Ayala On 02/24/2022 at 03:16 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 PLUM CANYON
FACILITY NUMBER: 197750091

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/24/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
02/24/2022
Section Cited
CCR
101223(a)(2)

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Personal Rights: The licensee shall ensure that each child is accorded the following personal rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met as evidence by: Based on interviews and record review, C1 obtained a finger injury due
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Head of school stated, that staff will ensure that chidren are not near the doors when staff are exiting the classroom. Head of school stated the facility has installed safety guards on the door frame to prevent future injuries.
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to classroom door closing on C1's finger and C1 needing medical attention that resulted in C1's finger to be cut and C1's nail to be split in half.
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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:Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE:
DATE: 02/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/24/2022


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: GUIDEPOST MONTESSORI AT PLUM CANYON
FACILITY NUMBER: 197750091
VISIT DATE: 02/24/2022
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S2 stated that C1 has had a tendency to run towards the classroom doors when they are open or when S1 and S2 are leaving. When S2 heard C1 crying and screaming, S2 placed infant 1 down and attended to C1's injury. S2 stated that she saw blood and immediately applied pressure with a paper towel. Once bleeding stopped S2 brought C1 into lobby area where C1 was treated with first aid and parents were called and informed about incident. C1 was taken to the emergency room where no stiches/glue were needed. C1 remained out of school for the remainder of the week and returned the following Monday (04/26/2021).

Head of school was reminded of reporting requirements for unusual incident reports that occur at the facility.

A type B deficiency is being cited today in according with Title 22 Regulation, Reporting Requirements 101212(d)(1)(2).

An immediate civil penalty of $500 is being assessed and $100 will accrue until the deficiency is corrected.

The facility is being cited a Type A deficiency according to the California Code Title 22 Regulations, 101223(2). This citation poses an immediate health and safety risk. See LIC 809D for deficiencies.
Upon receipt of a Type A deficiency licensee shall post the report for 30 days in addition to the Notice of Site Visit & provide copies of the licensing report to parents/guardians of children in care at the facility. This report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee will obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file. If these requirements are not met, civil penalties will be assessed.

An exit interview was conducted, a copy of this report and appeal rights was provided to Head of School along with Notice of Site Visit.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 02/24/2022 04:56 PM - It Cannot Be Edited


Created By: Monique Jessica Ayala On 02/24/2022 at 03:41 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 PLUM CANYON
FACILITY NUMBER: 197750091

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/24/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/04/2022
Section Cited
CCR
101212(d)(1)(2)

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Reporting Requirement: Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours.
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Head of school, stated she will report incident reports during working hours.
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In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. This requirement was not met as evidence by: Based on observation, interivew and record review, facility did not file incident report in timely manner.
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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:Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE:
DATE: 02/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/24/2022


LIC809 (FAS) - (06/04)
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