198019814-10-24-2023-33-CC-LBAK-CWWUPP-20231024154551

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019814
Report Date: 10/24/2023
Date Signed: 10/24/2023 03:45:56 PM

Document Has Been Signed on 10/24/2023 03:45 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: 74	DATE:	10/24/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Director, Maribeth Peralta		TIME COMPLETED:	04:00 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 7/28/23 and was reported to the Department on 7/28/23. A COVID risk assessment was conducted. LPA met with Director, Maribeth Peralta to whom the reason for the visit was explained. Director guided LPA on a tour of the facility. Census was taken. There were 7 staff present caring for 74 children. The facility was observed to be operating within the license capacity limitations. On July 18, 2023, an unusual incident report was made to the Department regarding an incident that involved a child who sustained an injury that required medical attention. The facility reported this incident to the Department within the required 24 hours. Based on information obtained during interviews conducted with staff on 7/28/23, LPA Babcock determined that during outdoor play Child #1 (C1) was running to the table to get a water bottle and tripped over their feet, fell on their knees, and hit their forehead on the edge of the bench seat of the metal picnic table. C1 sustained an injury to their right eyebrow in the form of an open cut approximately 1 inch long. On the day of the incident, LPA inspected the outdoor area and did not observe any hazards near or on the area where incident took place. Based on interviews with staff, there was adequate supervision at the time of the incident. It appears that although staff were present, they could not prevent the injury. Paramedics were called to the facility and C1 was taken to the hospital and received stitches. Child has returned to day care. Page 1 of 2

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

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: 10/24/2023

NARRATIVE

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Based on information obtained during this investigation, no additional follow up is necessary regarding the incident reported. The facility followed all proper procedures; Staff administered first aid and paramedics were called, child’s parent was notified, incident report was sent in properly and timely, and all medical needs were met.

No deficiencies are being cited at this time.

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: 10/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

LIC809 (FAS) - (06/04)

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