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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019814
Report Date: 06/07/2021
Date Signed: 06/07/2021 05:24:42 PM

Document Has Been Signed on 06/07/2021 05:24 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:PRIMANTI MONTESSORI ACADEMYFACILITY NUMBER:
198019814
ADMINISTRATOR:HISSANKA GUNASEKARAFACILITY TYPE:
850
ADDRESS:10947 VALLEY HOME AVETELEPHONE:
(562) 943-0246
CITY:WHITTIERSTATE: CAZIP CODE:
90603
CAPACITY: 124TOTAL ENROLLED CHILDREN: 0CENSUS: 71DATE:
06/07/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:31 PM
MET WITH:Director, Maribeth PeraltaTIME COMPLETED:
03:00 PM
NARRATIVE
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An unannounced tele-inspection was conducted by Licensing Program Analyst (LPA) Jose Guzman on 06/07/2021 via FaceTime due to COVID-19 and precautionary measures. The tele-inspection was conducted with Director Maribeth Peralta, to whom the purpose of the inspection was announced. The purpose of the tele-inspection was to conduct a Case Management deficiency inspection in order to cite for a deficiency discovered during an investigation. There were 71 children observed to be present with 8 staff at the facility during this tele-inspection.

A citation is being issued for the following deficiency:

During an investigation conducted on 04/30/2021, LPA was informed that the facility has operated out of ratio on multiple occasions. Through an LPA interview with the Director on 05/04/2021, by the Director’s own admission, the facility has operated out of ratio for 5 to 10 minutes during transition of activities, covering for staff breaks and lunches, and due to limited staff.

Please refer to 809D for documentation of deficiencies.

A copy of this report must be provided to the authorized representatives of all currently enrolled children and must also be provided to newly enrolled children for the next 12 months. The report shall be provided no later than the next business day or the next day the child is in care.



The ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC9224) shall be signed and kept in each of the children’s records. Web site address to obtain forms, review quarterly updates, review Title 22 & Health & Safety Codes is: www.ccld.ca.gov.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Jose Guzman
LICENSING EVALUATOR SIGNATURE: DATE: 06/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2021
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: PRIMANTI MONTESSORI ACADEMY
FACILITY NUMBER: 198019814
VISIT DATE: 06/07/2021
NARRATIVE
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An exit FaceTime interview has been conducted with Director, Maribeth Peralta. Appeal Rights were verbally explained to the Director. A copy of this report has been signed by LPA Jose Guzman. This report along with the Appeal Rights will be e-mail to the Director, who understands that an electronic “Read Receipt” and/or confirmation of receipt of the e-mail confirms receipt of the report and constitutes an electronic signature. The Director agrees to sign the bottom of each page of the report and return the originals to LPA Jose Guzman in-person or via U.S. Mail. A Notice of Site Visit was not provided to Director since a physical inspection was not conducted.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Jose Guzman
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/07/2021 05:24 PM - It Cannot Be Edited


Created By: Jose Guzman On 06/07/2021 at 05:07 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: PRIMANTI MONTESSORI ACADEMY
FACILITY NUMBER: 198019814

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/07/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/07/2021
Section Cited
CCR
101216.3(a)

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101216.3 Teacher-Child Ratio: (a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance. The requirement is not met as evidenced by:
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Per Director, additional staff has been hired to meet the teacher to child ratio. An all staff training will be provided regarding teacher to child ratios. LPA Jose Guzman will be provided with a copy of the sign-in sheet and training agenda by the POC due date of 06/11/2021.
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Based on Licensing Program Analyst (LPA) interviews conducted, the Director did not ensure that the facility maintain teacher to child ratio during transition of activities, staff breaks and lunches, and due to limited staff. This poses an immediate Health, Safety and/or Personal Rights 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:Jose Guzman
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2021


LIC809 (FAS) - (06/04)
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