198019814-10-13-2023-33-CC-LBAK-CWKVCH-20231013161910

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019814
Report Date: 10/13/2023
Date Signed: 10/13/2023 04:20:02 PM

Document Has Been Signed on 10/13/2023 04:20 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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	PRIMANTI MONTESSORI ACADEMY		FACILITY NUMBER:	198019814
ADMINISTRATOR:	HISSANKA GUNASEKARA		FACILITY TYPE:	850
ADDRESS:	10947 VALLEY HOME AVE		TELEPHONE:	(562) 943-0246
CITY:	WHITTIER	STATE: CA	ZIP CODE:	90603
CAPACITY: 124	TOTAL ENROLLED CHILDREN: 105	CENSUS: 79	DATE:	10/13/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Director, Maribeth Peralta		TIME COMPLETED:	04:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Lilli Babcock conducted an unannounced Case Management inspection due to an incident that occurred on 10/11/23 and was reported to the Department on 10/12/23. A COVID risk assessment was conducted. LPA met with Director, Maribeth Peralta to whom the reason for the visit was explained. Ms. Peralta guided LPA on a tour of the facility. Census was taken. There were 10 staff present caring for 79 children. The facility was observed to be operating within the license capacity limitations. On October 12, 2023, an unusual incident report was made to the Department regarding an incident that involved a child in care who exited the facility gates unsupervised. The facility reported this incident to the Department within the required 24 hours. At 10:08 a.m. during this visit, LPA inspected the 2 entry/exit gates and observed them to be closed and latched on this day. The main gate is metal with an arched top that reaches almost to the ceiling and cannot be opened from outside the facility without a code. The second gate is also metal and approximately 5 feet tall. The second gate can be opened from inside or outside the facility. Beyond the second gate is an asphalt area approximately 13-14 feet long and beyond that area is the parking lot. At 12:00 pm during this visit, Director showed LPA the facility video footage of the incident. The Director stated the footage was from 3 cameras that captured Child #1 (C1) from the outdoor play area to the entry/exit gates. Based on information obtained during interviews conducted with staff, and after reviewing the facility video footage of the incident, LPA Babcock determined that the incident began Page 1 of 3

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023

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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: PRIMANTI MONTESSORI ACADEMY	FACILITY NUMBER: 198019814
	VISIT DATE: 10/13/2023

NARRATIVE

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at approximately 4:11 pm while Child #1 (C1) was on the play yard. Per Director, the outdoor yard was supervised by 8 Staff on this day (Staff #2, Staff #3, Staff #4, Staff #5, Staff #6, Staff #7, Staff #8, Staff #9). The video shows Staff #3 (S3) positioned on the play yard near the door to the Long Room but S3 leaves the location shortly before C1 enters the video. During LPA interview, S3 stated “a child bit their tongue that day, and I had to get them a tissue and another teacher got an ice pack, and I was sitting with that child on the bench”.
LPA observed the video footage to show C1 walk through the doors leading from the outside play area to the Long Room (hallway). It appears in the video footage that another child being accompanied by Staff #2 (S2), opened the door from inside the Long Room and then both the child and S2 exited to the outdoor play area, as C1 walked through the open door. In a declaration, Staff #2 stated “I was walking back to the playground. C1 was at the entrance of the door and was about to walk inside into the Long Room. I asked C1 where they were going and C1 told me they were going home. I let C1 pass through into the Long Room”. LPA then observed the footage of C1 walking through the Long Room without supervision, turning left at the end of the hall without supervision, walking out the Long Room doors without supervision, turning right and walking up the 5 stairs to the 2 exit gates without supervision, and exiting the first gate behind a parent that had picked up their child and was also exiting the main gate. After C1 walked through the main gate, the gate self-closed and latched. Video footage showed the second exit gate at the facility was open, and C1 was able to walk past the second gate unsupervised as well. C1 then walked approximately 2 steps further before stopping and walking back toward the main gate. LPA observed other parents outside the gate waiting to pick up their children. The video shows Staff #1 (S1) enter the frame from the direction of the facility office and walk to the inside of the gate. Video shows C1 outside the gate, and S1 opening the gate and bringing C1 back inside the gate. S1 stated in a declaration, “I was assigned to be at the school gate to release children for afternoon dismissal from 3:00 – 4:30 pm…I stepped out from the gate that was closed to check the school email in the office. It took me about a minute to check the school email from my computer and rushed out back to the gate only to find out that C1 was outside the gate and a parent told me who were waiting outside the gate that C1 came out.” LPA observed the video shows C1 was outside the gates
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023

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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: PRIMANTI MONTESSORI ACADEMY	FACILITY NUMBER: 198019814
	VISIT DATE: 10/13/2023

NARRATIVE

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for approximately one minute. Based on interviews with staff, and video footage reviewed during this investigation, C1 was unsupervised during the time C1 left the outdoor play area, entered the facility hallway (Long Room), exited the Long Room, climbed 5 stairs, exited the main gate and second gate and waited outside the facility gates until being let back inside the gate by S1.

LPA obtained the Facility Incident Report that was given to the parent of C1 documenting the incident, Declarations from Director, Staff #1, Staff #2, and Staff #3, and requested Director email LPA the video footage of the incident.

Based on LPA’s interviews with staff, and video footage of the incident observed by LPA, 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 and safety.

LPA Babcock informed facility representative, Maribeth Peralta that this report dated 10/13/23 documents one Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Lilli Babcock informed the facility representative to provide a copy of this licensing report dated 10/13/23 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.

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.

Exit interview conducted and report was reviewed with Director, Maribeth Peralta.
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/13/2023 04:20 PM - It Cannot Be Edited

Created By: Lilli Babcock On 10/13/2023 at 03:08 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: 10/13/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 10/17/2023 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	101229 Responsibility for Providing Care and Supervision (a)...(1) No child(ren) shall be left without the supervision of a teacher at any time...Supervision shall include visual observation. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Director states she will develop a plan to ensure children are not left unsupervised and email to LPA.
	8 9 10 11 12 13 14	Based on interview and review of video, the licensee did not comply with the section cited above in 1 of 105 children in care who were left unsupervised and exited facility gates without supervision which poses/posed an immediate health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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:

Brandi VanOosten

LICENSING EVALUATOR NAME:

Lilli Babcock

LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023

LIC809 (FAS) - (06/04)

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