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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016141
Report Date: 04/06/2023
Date Signed: 04/06/2023 01:28:22 PM

Document Has Been Signed on 04/06/2023 01:28 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:MONTESSORI SCHOOL OF HACIENDA HEIGHTSFACILITY NUMBER:
198016141
ADMINISTRATOR:ENOKA ATTALEFACILITY TYPE:
850
ADDRESS:15207 E. LOS ROBLES AVENUETELEPHONE:
(626) 968-0500
CITY:HACIENDA HEIGHTSSTATE: CAZIP CODE:
91745
CAPACITY: 122TOTAL ENROLLED CHILDREN: 50CENSUS: 31DATE:
04/06/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Enoka AttaleTIME COMPLETED:
01:45 PM
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Licensing Program Analysts (LPAs) Carolyn Tuba and Mary Silva conducted an unannounced case management inspection on 4/06/2023. A COVID 19 risk assessment was conducted prior to entering the facility. LPAs arrived at the facility at 09:00 am and met with Director, Enoka Attale, who provided a tour of the facility. There were 31 children and 5 staff present during the inspection.

The purpose of today's inspection is to go over the water lead test results received on 03/01/2023. Per Director she had not received results of the lead testing. Results indicate that "B” and “C” water sources had action level exceedance of lead. The water fountain located outside by room 1 had a lead result of 8. The faucet in the kitchen sink had a lead result of 19. LPAs observed that faucets are not accessible through signage with bags and tape to make them inaccessible to children in care, as well as staff. The water fountain located outside per Director will be removed and kitchen sink will be repaired. LPAs spoke with the Director, who stated that the children bring their own lunch and facility provides hot lunch and snacks from Costco. Facility uses Styrofoam trays and cups, as well as utensils that are thrown away. Children bring water from home in their personal drinking container. If children forget to bring water from home, they are provided bottled water. LPAs took pictures of the kitchen water faucet and water fountain during the inspection. Per Director water fountain has not been used since March of 2020, but previous to that date, children had access. LPAs were provided the LIC 9275, LIC 9276, Facility Sketch and receipt of lead testing form. LPAs provided a copy to the Director of PIN 21-21.1-CCP (Written Directives for Lead Testing of Water). After further investigation, LPAs learned that kitchen sink is used to make coffee for staff and juice for the children.
A deficiency was cited to ensure that the water faucets noted will not be used as a drinking source or food preparation source for the children.
The deficiency listed on the following page were observed by the LPAs and is being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809-D. The deficiency that is being cited needs to be cleared to protect the children’s health & safety.
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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/06/2023
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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Document Has Been Signed on 04/06/2023 01:28 PM - It Cannot Be Edited


Created By: Carolyn Tuba On 04/06/2023 at 12:18 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: MONTESSORI SCHOOL OF HACIENDA HEIGHTS
FACILITY NUMBER: 198016141

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/08/2023
Section Cited
CCR
101700.3(b)(1)-(b)

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101700.3(b)(1) California Lead Action Level at Child Care Centers. (b) Testing results with...readings of 0.5 ppb or greater..., before comparing to the Action Level. (1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement is not met as evidenced by:
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Per Director outside water fountain will be removed and kitchen sink will be repaired. Both outlets has been covered with garbage bag and appropriate "Out of Use" signage posted around it. Facility will continue to provide LPAs with the status and updates regarding the kitchen faucet re-test planned after repair.
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Based on record review, the Director did not comply with the directive above, as two outlets (outlet used for food preparation in the kitchen) and (outside water fountain outlet) out of five outlets tested with an Action Level Exceedance (ALE). This poses an immediate Health and Safety risk to children in care.
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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:Ana Chico
LICENSING EVALUATOR NAME:Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:
DATE: 04/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/06/2023


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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MONTESSORI SCHOOL OF HACIENDA HEIGHTS
FACILITY NUMBER: 198016141
VISIT DATE: 04/06/2023
NARRATIVE
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LPAs provided Director with Official test results for their facility. Director must post outside for parents to view lead testing results, since parent board is located inside the office.

Exit interview conducted and a copy of this report, along with appeal rights was given to staff member, Patricia Vallejo, due to Director having to leave to a previous engagement. A notice of site visit was given and must remain posted for 30 days or a $100 civil penalty may be assessed.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023
LIC809 (FAS) - (06/04)
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