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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750091
Report Date: 03/03/2022
Date Signed: 03/03/2022 05:39:29 PM

Document Has Been Signed on 03/03/2022 05:39 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: 30DATE:
03/03/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Gina Castello, Head of SchoolTIME COMPLETED:
03:00 PM
NARRATIVE
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On March 3, 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 09/22/2021; 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 30 children and 12 staff present today.

Description of incident: On 09/22/2021 at approximately 11am, Child 1 was running to see the sanitation truck as he followed the truck along side the hill child tripped. C1 tripped and hit his head on the brick wall. S1 brought C1 to the office where first aid was applied. C1's mother was notified about the incident. C1 was taken to urgent care by mother and received 2 stiches on his head. C1 was allowed to return to school on Friday, 09/24/2021 per Doctor.

The information obtained during the interviews revealed that the head injury to C1 was caused by the landscaping of the play yard. LPA's observed the play yard to be uneven and there are dips within the hill that leads to the brick wall where C1's injury occurred.

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, 101238.2(d)(1). This citation poses an immediate health and safety risk. See LIC 809D for deficiencies.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE: DATE: 03/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/03/2022
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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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: 03/03/2022
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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: 03/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/03/2022 05:39 PM - It Cannot Be Edited


Created By: Monique Jessica Ayala On 03/03/2022 at 03:08 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: 03/03/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
03/04/2022
Section Cited
CCR
101238(a)

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Buildings and Grounds: The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees...This requirement was not met as evidence by: Based on observation and interviews, C1 obtained a head injury that required medical attention due to the play yard being
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Head of School stated that any holes/dips that are present on the play yard will be filled with soil by POC date.
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uneven and having dips withing the grass.
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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: 03/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/03/2022


LIC809 (FAS) - (06/04)
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