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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015474
Report Date: 05/29/2024
Date Signed: 05/29/2024 02:38:47 PM

Document Has Been Signed on 05/29/2024 02:38 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:MONTROSE CHRISTIAN MONTESSORI SCHOOLFACILITY NUMBER:
198015474
ADMINISTRATOR/
DIRECTOR:		RIMA CHRISTINA DIBIEFACILITY TYPE:
850
ADDRESS:2545 HONOLULU AVENUETELEPHONE:
(818) 249-2319
CITY:MONTROSESTATE: CAZIP CODE:
91020
CAPACITY: 105TOTAL ENROLLED CHILDREN: 105CENSUS: 32DATE:
05/29/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:27 PM
MET WITH:Sharon Lee TIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Shushanik Safaryan conducted an unannounced Case Management Inspection to the above facility . Upon arrival LPA met with the Facility Representative Sharon Lee who guided LPA on a tour of the facility . During the visit LPA observed 32 children with 7 staff members .

Per section 101212 Reporting Requirements , licensee shall notify the Department upon the occurrence , during operation of the childcare center of any events specified in (d) (1) below, and reports shall be made to the Department by telephone or fax within the Department`s next working day and during its normal hours . In addition, a written report containing the information specified shall be submitted to the Department within seven days following the occurrence of such event .
On 12/19/23 Facility had a biting incident .Child #2 bit Child #1 on the right arm. During the file review LPA observed Communication memos prepared and provided to the parents by the facility .(Copies obtained ). Facility did not report this incident to the Department, which poses/posed a potential health, safety, or personal rights risk to persons in care.
Based on the information obtained the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22.
Deficiencies that are being cited need to be cleared to protect the children’s health & safety.
The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit 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 and explained to Facility Representative , Sharon Lee along with Appeal Rights.

End of the Report
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE: DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/29/2024
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 05/29/2024 02:38 PM - It Cannot Be Edited


Created By: Shushanik Safaryan On 05/29/2024 at 02:17 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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MONTROSE CHRISTIAN MONTESSORI SCHOOL
FACILITY NUMBER: 198015474

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/12/2024
Section Cited
CCR
101212d(1)C

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101212Reporting Requirements d)Upon...occurrence.. any... events specified..below, report shall be made ... by telephone...fax within the.. next working day and during... business hours...(1)Events reported..(C)Any unusual incident..This requirement is not met evidenced by
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Licensee will review reporting requirements with Administration staff and teachers and will send the metting memo to the LPA by POC date .
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During the insoection LPA obtained information reagding biting incident between child #1 and child #2 that was not reported to the Department . LPA obtained communication memos prepared for the parents by the facility regarding the incident .
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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:Claudia Guangorena
LICENSING EVALUATOR NAME:Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:
DATE: 05/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/29/2024


LIC809 (FAS) - (06/04)
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