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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750091
Report Date: 03/02/2022
Date Signed: 03/02/2022 04:21:14 PM

Document Has Been Signed on 03/02/2022 04:21 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: 36DATE:
03/02/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Gina Castello, Head of SchoolTIME COMPLETED:
04:45 PM
NARRATIVE
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On March 2, 2022, Licensing Program Analysts (LPAs) Monique Ayala and Isabel Ortega conducted a case management inspection to follow up on an Unusual Incident reported to the department by telephone on 10/11/2021; this incident was reported timely. LPAs were greeted by head of school who guided LPAs on a tour of the facility. Upon arrival, there were 36 children and 14 staff present today.

Description of incident: On 10/11/2021, Child 1 was crying when staff 1 picked up C1 she went unconscious for 10-15 seconds. C1 woke up in S1 arms and resumed crying.

After further review, the department determined that S1 failed to call 911, and instead contacted C1's mother. C1 was taken to the emergency room by mother.

A type B deficiency is being cited in accordance with Title 22 Regulation 101226(b)(c).

A copy of this report along with Appeal Rights and Notice of Site Visit was provided to Head of School.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE: DATE: 03/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/02/2022
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 03/02/2022 04:21 PM - It Cannot Be Edited


Created By: Monique Jessica Ayala On 03/02/2022 at 03:57 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: 03/02/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/18/2022
Section Cited
CCR
101226(b)(c)

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Health-Related Services: The licensee shall make prompt arrangements for obtaining medical treatment for any child if necessary. The licensee shall obtain emergency medical treatment without specific instructions from the child's authorized representative if the authorized representative cannot be reached immediately,
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Head of school will retake the preventative health and safety training by POC date and forward certificate to LPA.
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or if the nature of the child's illness or injury is such that there should be no delay in getting medical treatment for the child. This requirement was not met as evidence by: Based on interview and record review, staff disclosed that 911 was not called for C1 becoming unconscious. This poses a 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:Mariela Ramon
LICENSING EVALUATOR NAME:Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE:
DATE: 03/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2022


LIC809 (FAS) - (06/04)
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