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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750092
Report Date: 07/15/2021
Date Signed: 07/15/2021 02:31:56 PM

Document Has Been Signed on 07/15/2021 02:31 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:
197750092
ADMINISTRATOR:AARON BAILEYFACILITY TYPE:
850
ADDRESS:19141 SKYLINE RANCH RDTELEPHONE:
(949) 354-2259
CITY:SANTA CLARITASTATE: CAZIP CODE:
91350
CAPACITY: 102TOTAL ENROLLED CHILDREN: 0CENSUS: 38DATE:
07/15/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Martha Gerogie, Head of SchoolTIME COMPLETED:
12:00 PM
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After supervisors review, on 07/15/2021 LPA Monique Ayala amended this report to include that the facility was in compliance with Title 22 Regulations and this incident was accidental.

On 07/15/2021, 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 07/09/2021; this incident was reported timely. LPA was greeted by head of school who guided LPA on a tour of the facility. Upon arrival, there were 38 children and 5 staff present today.

Description of the incident: An incident on 07/09/2021 at approximately 3:40pm, child #1 was running in the classroom when she tripped over her shoes (crocs) and hit her head on the bookshelf by her hairline. C1 sustained an inch long deep cut along the middle of her hairline resulting in bleeding for approximately 3 minutes. Staff #1 applied pressure, provided C1 with an ice pack and when bleeding stopped S1 provided C1 with a band aid. Staff #2 called Head of School to inform her of the incident. C1's parent was called and C1 was taken to urgent care where C1 received 4 stiches.

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

The information obtained during interviews conducted revealed that staff #1 was in an area of the classroom that was closed to C1’s proximity; however, the incident occurred very fast and staff was not able to prevent the accident. The facility staff took the appropriate measures following the incident as they applied first aid, contacted C1’s parent, and reported the incident to the department within the 24-hour reporting requirement period. Head of school is encouraged to continue to report unusual incidents that occurred at the facility.

No violation of Title 22 Regulations occurred due to the incident being an accident. No deficiencies cited during this inspection.

An exit interview was conducted and a copy of this report was provided to head of school via email.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE: DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/15/2021
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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