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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198003765
Report Date: 03/17/2023
Date Signed: 03/17/2023 12:25:44 PM

Document Has Been Signed on 03/17/2023 12:25 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:NEW MONTESSORI SCHOOL, THEFACILITY NUMBER:
198003765
ADMINISTRATOR:G. SHAUGHNESSYFACILITY TYPE:
850
ADDRESS:15243 E. NELSON AVENUETELEPHONE:
(626) 369-4335
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY: 55TOTAL ENROLLED CHILDREN: 39CENSUS: 31DATE:
03/17/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Geraldine ShaughnessyTIME COMPLETED:
12:30 PM
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On March 17, 2023, at 10:00 am Licensing Program Analyst (LPA) Carolyn Tuba conducted a case management inspection due to an incident that occurred at the facility on 12/15/2022. LPA met with Director, Geraldine Shaughnessy and Staff, Jennifer Robles who guided LPA on a tour to obtain the census of 31 children with 6 staff. LPA conducted interviews and obtained documentation.


The incident was reported to the Department within the required 24 hours of occurrence. The incident consisted with a child having an injury that required medical attention.

Based on all the information obtained and interviews conducted with the Director who observed the incident and interviewed the child who sustained the injury. LPA found that the incident was an accident, and the child has recovered after injury of falling from going down the slide from a play structure and causing a breakage of his right arm. LPA obtained a copy of the medical report and spoke to parent who verified that she had received an injury report from the facility. LPA took a photo of the play structure.

No deficiencies were cited today regarding today’s inspection.



The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

An exit interview was conducted, and a copy of this report was provided to Director, Geraldine Shaughnessy along with Appeal Rights.

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 03/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/17/2023
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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