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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016235
Report Date: 06/01/2023
Date Signed: 06/01/2023 02:53:51 PM

Document Has Been Signed on 06/01/2023 02:53 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:ARROW MONTESSORI SCHOOL - SAN DIMASFACILITY NUMBER:
198016235
ADMINISTRATOR:CAROLINA DEVILLA-CRELENCIAFACILITY TYPE:
850
ADDRESS:818 WEST GLADSTONE STREETTELEPHONE:
(909) 599-0025
CITY:SAN DIMASSTATE: CAZIP CODE:
91773
CAPACITY: 64TOTAL ENROLLED CHILDREN: 54CENSUS: 43DATE:
06/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:41 PM
MET WITH:Carolina Devilla-CrelenciaTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Jennifer Hua conducted an unannounced Required - 1 year inspection. LPA met with Director Carolina Devilla-Crelencia. A COVID-19 risk assessment was conducted prior to entry to the facility. LPA provided a copy of the LIC 125 Entrance Checklist to facilitate the inspection. This is a preschool program. Business hours are from Monday to Friday, 6:00 AM to 6:00 PM. There is a also a private K-8th school on the premise.
LPA was guided to a facility tour by Director at 12:51pm . Children were napping during the tour. All areas identified on the Facility Sketch were inspected. There are 3 classrooms for the preschool program: The following were observed:
  • Classroom #C - 19 children with 1 staff.
  • Classroom #B - 16 children with 2 staff
  • Classroom PS1 - 8 children with 1 staff.
The facility was observed to be within the license capacity and limitations. Children's roster was reviewed. Sign-In and Sign-Out sheets were reviewed.
The following were observed during the tour of the facility:
Furniture and equipment were inspected for age appropriateness and good repair, telephone service (land line in the office), heating, lighting and ventilation were evaluated. All floors were observed to be clean and safe. All materials accessible to children were observed to be toxic free. Per Director, there were no firearms stored on the premises and there is a swimming pool on the premise. LPA observed fencing requirements meet Title 22 regulations at this time. The swimming pool is completely surrounded. 3 sides are made of iron gate and the 4th side is center block. The iron gate is 5'8 inches tall. It is 2 inches from the ground and the space in between the bars are less than 4 inches wide. There is one singular entrance into the pool area. The entrance gate swings away from the pool and has a self latching gate and it is locked. The center block wall is 5'5 inches tall.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Jennifer Hua
LICENSING EVALUATOR SIGNATURE: DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/01/2023
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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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: ARROW MONTESSORI SCHOOL - SAN DIMAS
FACILITY NUMBER: 198016235
VISIT DATE: 06/01/2023
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Children have their own cubby to store their belongings. Cots are stacked. Blankets/sheets are sent home to be wash every Friday. Per Director, the isolation area is in the office. Age appropriate sinks and toilets were inspected for availability and good repair in all restrooms. General sanitation was observed. Availability of indoor drinking water was observed in the classroom. First Aid supplies were on top shelves in every classroom and one in the kitchen.
Disinfectants, cleaning solutions, and other items that are dangerous to children were inaccessible. Carbon monoxide and smoke detectors were observed in the classrooms. All kitchen areas/food preparation areas and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin.
All storage containers for solid waste, including moveable bins have tight-fitting covers that are kept on, and in good repair. Trash cans used to discard food have tight fitting lids. Per director, parents bring snacks and lunch for their child since covid. Facility will have snacks available for children. Menu was observed to be posted for the month. Drills were conducted in October 2022. Outdoor playground equipment is in a safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. The outdoor surface is cushioned with rubber turf that absorbs a fall. There is adequate shade in the play yard. Per director, outdoor drinking water will be brought when children are outside. LPA advised that no children shall be left without the supervision of a teacher at any time. All individuals present have obtained a criminal record clearance or criminal record exemption. There is at least one person trained in CPR and Pediatric First Aid present during this inspection. The review of Staff records was documented on the LIC 859. Staff present have proof of the AB 1207 Mandated Reporter Training certificate on file. Staff present have proof against TB, measles, pertussis, and influenza.

This facility provides Incidental Medical Services - IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children's, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA information Line at (800) 514-0301(voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm Per director, no children require IMS at this time.

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Jennifer Hua
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023
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: ARROW MONTESSORI SCHOOL - SAN DIMAS
FACILITY NUMBER: 198016235
VISIT DATE: 06/01/2023
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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/tion-process.

Deficiency cited on 809D.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Director.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Jennifer Hua
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4
Document Has Been Signed on 06/01/2023 02:53 PM - It Cannot Be Edited


Created By: Jennifer Hua On 06/01/2023 at 02:29 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: ARROW MONTESSORI SCHOOL - SAN DIMAS
FACILITY NUMBER: 198016235

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/01/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101174(d)
Disaster and Mass Casualty Plan
(d) Disaster drills shall be conducted at least every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in drills were last conducted in October 2022, which was 8 months ago, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/08/2023
Plan of Correction
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Per director, will schedule to conduct drills on 6/8/23 and will submit copy of drill log to LPA by POC due.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Jennifer Hua
LICENSING EVALUATOR SIGNATURE:
DATE: 06/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2023


LIC809 (FAS) - (06/04)
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