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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750092
Report Date: 03/03/2022
Date Signed: 03/03/2022 05:41:57 PM

Document Has Been Signed on 03/03/2022 05:41 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: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 31DATE:
03/03/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Gina Castello, Head of SchoolTIME COMPLETED:
06:00 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 which was reported to the department by telephone on 03/02/2022; 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 31 children and 7 staff present today.

Description of incident: On 03/01/2022, during outdoor playtime, C1 opened the gate and walked towards the parking lot. C1 took serval steps outside of the facility and staff 1 saw that C1 exited the play yard and brought C1 back into the facility play yard through the gate C1 exited.

During todays inspections LPAs interviewed, Assistant Head of School, staff, obtained images of outdoor play yard, parking lot and obtained a copy of the facility roster.

The information obtained during the interviews revealed that, C1 was sitting on the table near the gate leading to the parking lot. S1 saw C1 playing with the door knob and told C1 not to open the gate. C1 continued to open the gate and ran out of the play yard. S1 was able to run to C1 and bring child back into the play yard before C1 made it into the parking lot.

The facility is being cited a Type B deficiency according to Title 22 Regulations, 101223(a)(2).

An exit interview was conducted, a copy of this report was provided along with appeal rights and a 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
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 03/03/2022 05:41 PM - It Cannot Be Edited


Created By: Monique Jessica Ayala On 03/03/2022 at 05:06 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: 197750092

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/03/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/18/2022
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 ... to meet his/her needs. This requirement was not met as evidence by: Based on interviews, staff disclosed that C1 was able to exit the facility through the play yard gate
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Head of school, will install door alarm to the gate leading into the parking lot by the POC date.

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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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