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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017610
Report Date: 08/24/2022
Date Signed: 08/24/2022 08:09:17 PM

Document Has Been Signed on 08/24/2022 08:09 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:MCKINLEY MONTESSORI ACADEMYFACILITY NUMBER:
198017610
ADMINISTRATOR:RACHEL CORDOVAFACILITY TYPE:
830
ADDRESS:217 E. MCKINLEY AVENUETELEPHONE:
(909) 620-8400
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY: 12TOTAL ENROLLED CHILDREN: 3CENSUS: 1DATE:
08/24/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Asst. Site Supervisor Lisa SeggelkeTIME COMPLETED:
06:00 PM
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On this date, Licensing Program Analyst (LPA) Emiko Bell conducted an unannounced Annual/Required-1 year inspection. Upon LPA's arrival at 10:00 am, LPA Bell entered the code to enter the gate then walked to the front office. As no one was in the front office, LPA Bell proceeded toward the Infant room. While passing the Infant playground, LPA Bell observed two Infant teachers with one infant on the playground. LPA Bell then inquired after Assistant Site Supervisor Lisa Seggelke. LPA Bell proceeded to the back office, where she was greeted by Site Supervisor Rachel Cordova and Asst. Site Supervisor Seggelke. LPA then announced the purpose of the inspection to both before proceeding to the Infant room.

Census: There were two staff with one infant on the playground at 10:05 am. Staff-child ratio was met. Both staff are cleared and associated.

Throughout the duration of the inspection, LPA and staff wore face coverings as a precautionary measure against COVID-19. The COVID screening questions were posed to Asst. Site Supervisor Lisa Seggelke and all were responded to with "No."

Upon leaving the infant room, LPA toured the kitchen area.

This is an infant program licensed for 12 infants which operates Monday – Friday from 07:00 am-05:00 pm.
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Betty Bell
LICENSING EVALUATOR SIGNATURE: DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/24/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: MCKINLEY MONTESSORI ACADEMY
FACILITY NUMBER: 198017610
VISIT DATE: 08/24/2022
NARRATIVE
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The Program Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA advised the licensee to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.



LPA discussed the safe sleep regulations with Program Director Rachel Cordova and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Program Director Cordova of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

LPA Bell informed Program Director Rachel Cordova that this report dated 08/24/22 documents one Type A citation, which shall be posted for 30 consecutive days, as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Betty Bell
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022
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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: MCKINLEY MONTESSORI ACADEMY
FACILITY NUMBER: 198017610
VISIT DATE: 08/24/2022
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LPA observed the required postings (the license, the menu, LIC 613A Personal Rights, PUB 269 Child Car Seat Poster, PUB 369 Notification of Parent's Rights) to be posted on the Parent Board in the Infant classroom; the Emergency Disaster Plan is posted in the office. The fire drill log is also posted.

LPA observed the facility to be clean, safe, sanitary and in good repair. Furniture and equipment was inspected for good repair; free of sharp, loose, or pointed parts. At this time, if a child were to become ill, they would be kept in the infant room, separate from the other infants, and their parents would be contacted immediately.

During this time, children being in their own sippy cups. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are stored in cabinets which are rendered inaccessible by childproof latches. There is a fire extinguisher, smoke and a carbon monoxide detector that meet statutory requirements in the infant room

Outdoor play equipment was observed to be in good condition, free of sharp, loose or pointed parts. Outdoor activity space surface is maintained in a safe condition as is free of hazards. There is both artificial and real grass in the activity area for cushioning. Asst. Site Supervisor states there are no weapons or firearms on the premises.

The sign in and out app was reviewed. LPA observed that the person who signs the child in and out uses their full legal signature and that the time of the day is recorded.

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Betty Bell
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022
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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: MCKINLEY MONTESSORI ACADEMY
FACILITY NUMBER: 198017610
VISIT DATE: 08/24/2022
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Beginning at 11:00 am, LPA reviewed both staff and children's files. Staff records were reviewed to ensure the following are present: qualifications, proof of immunizations, current Pediatric First Aid & CPR certification, TB Clearance or Risk Assessment, LIC 503 Health Screening Report, LIC 508 Criminal Record Statement, LIC 9108 Statement Acknowledging Requirement to Report Child Abuse, Mandated Reporter Certificate and the LIC 9052 Notice of Employee Rights.

Children’s Records were reviewed to ensure that the following are present: LIC 613A Personal Rights, Admission Agreement, Infant Needs and Services Plan, LIC 700 Identification and Emergency form, LIC 701 Physician’s Report, LIC 995 Notification of Parents' Rights, LIC 627 Consent for Emergency Medical Treatment and Immunization Record.

The following deficiencies in compliance were observed on 08/23/22:

Type A: At 03:15, LPA Bell observed Child #1 (C1) sleeping with a blanket in their crib. When LPA asked Staff #2 (S2) why C1 has a blanket, S2 stated that C1 needs the blanket in order to fall asleep; normally, the blanket is removed once C1 falls asleep, but that today (08/23/22) S2 was "too busy" to remove the blanket. A photo was taken, but it was blurry. LPA Bell took a photo at 03:33 pm which shows the blanket hanging over the edge of the crib,.

Type B: At 03:00 pm, LPA Bell was informed by S2 that the infants do not have a Daily Activity Schedule. LPA Bell had asked S2 after LPA observed that there was not a Daily Activity Schedule posted on the Parent Board in the Infant classroom.
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Betty Bell
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022
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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: MCKINLEY MONTESSORI ACADEMY
FACILITY NUMBER: 198017610
VISIT DATE: 08/24/2022
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Staff #1 (S1) confirmed this and stated that the parents won't be able to sign in/out until one of the three people who have access to the application can input the parents' information. This is unacceptable because: parents do not sign in, only out; there is no hard copy documentation as a back-up; the app does not require a full legal signature, only that the child was signed in; and only the time the child arrives is documented on the Daily Log, not the time they leave.

During the 08/24/22 inspection, LPA Bell observed during records review that two of the infants' files do not have updated Needs and Services Plans.

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

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/process.

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Betty Bell
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022
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Document Has Been Signed on 08/24/2022 08:09 PM - It Cannot Be Edited


Created By: Betty Bell On 08/24/2022 at 05:46 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: MCKINLEY MONTESSORI ACADEMY
FACILITY NUMBER: 198017610

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/24/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101439.1(f)
Infant Care Center Sleeping Equipment
(f) Cribs shall be free from all loose articles and objects, including blankets and pillows.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on LPA's observation on 08/23/22,, when Child #1 was observed to be sleepoing in a crib with a blanket, the licensee did not comply with the section cited above in one out of two cribs, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/25/2022
Plan of Correction
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Per Program Director/Site Supervisor Rachel Cordova, the "Infant/Toddler Needs and Service Plan" will be updated to remove the wording regarding permissible use of blankets. A copy will be provided to LPA Bell upon completion. In addition, staff will be informed and checked on and the parents will be informed.
Section Cited
Deficient Practice Statement
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2
3
4
POC Due Date:
Plan of Correction
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2
3
4
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:Betty Bell
LICENSING EVALUATOR SIGNATURE:
DATE: 08/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/24/2022


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Document Has Been Signed on 08/24/2022 08:09 PM - It Cannot Be Edited


Created By: Betty Bell On 08/24/2022 at 05:46 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: MCKINLEY MONTESSORI ACADEMY
FACILITY NUMBER: 198017610

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/24/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101430(a)(1)
Infant Care Activities
(1) The infant care center shall develop, maintain and implement a written plan to ensure the provision of indoor and outdoor activities designed to meet the needs of infants, including but not limited to:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observation of the Parent Board and corroborated by Staff #2 on 08/23/22 at 03:00 pm, the infants do not have a Daily Activity Schedule. LPA Bell had asked S2 after LPA observed that there was not a Daily Activity Schedule posted on the Parent Board in the Infant classroom. Based upon LPA's observation, the licensee did not comply with the section cited above in one out of five postings, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/06/2022
Plan of Correction
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Program Director Rachel Cordova stated that she will provide LPA Bell with a copy of the Infant Daily Activity Schedule by the close of business on 09/06/22.
Section Cited
Administration of Child Day Care Licensing
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:Claudia Guangorena
LICENSING EVALUATOR NAME:Betty Bell
LICENSING EVALUATOR SIGNATURE:
DATE: 08/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/24/2022


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Document Has Been Signed on 08/24/2022 08:09 PM - It Cannot Be Edited


Created By: Betty Bell On 08/24/2022 at 05:46 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: MCKINLEY MONTESSORI ACADEMY
FACILITY NUMBER: 198017610

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/24/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101419.3(a)
Modifications to Infant Needs and Services Plan
(a) The written infant needs and services plan shall be updated at least quarterly, or as often as necessary to assure its accuracy.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in two out of three infants' files, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/06/2022
Plan of Correction
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2
3
4
Per Program Director Rachel Cordova, she will ensure that the Needs and Services Plan of Child #1 and Child #3 are updated. A copy of the updated plans will be provided to LPA Bell by the close of business on 09/06/22.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Betty Bell
LICENSING EVALUATOR SIGNATURE:
DATE: 08/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/24/2022


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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: MCKINLEY MONTESSORI ACADEMY
FACILITY NUMBER: 198017610
VISIT DATE: 08/24/2022
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Also, LPA Bell informed Program Director Rachel Cordova to provide a copy of this licensing report dated 08/24/22 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly-enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with the Program Director/Site Supervisor Rachel Cordova.

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Betty Bell
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022
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