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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021233
Report Date: 06/27/2023
Date Signed: 06/27/2023 03:04:48 PM

Document Has Been Signed on 06/27/2023 03:04 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:AZUSA MONTESSORI ACADEMYFACILITY NUMBER:
198021233
ADMINISTRATOR:CORDOVA, RACHELFACILITY TYPE:
850
ADDRESS:325 AZUSA AVENUETELEPHONE:
(909) 620-5100
CITY:AZUSASTATE: CAZIP CODE:
91702
CAPACITY: 46TOTAL ENROLLED CHILDREN: 46CENSUS: 0DATE:
06/27/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Rachel CordovaTIME COMPLETED:
03:15 PM
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An announced pre-licensing site inspection was conducted today by Licensing Program Analysts (LPA) Cynthia Reyes to inspect and measure the facility for capacity determination. Applicant is requesting a change of location from their previous license preschool program (F# 198012229) from 405 N. Azusa Ave. Azusa, Ca. 91702. Applicant is requesting a preschool license with capacity of 46 at this new location. This facility is located on the Azusa Hispanic foursquare Church site.

LPA met with applicant Rachel Cordova, Program Director, who guided analysts on a tour of the facility indoors and out. The facility operating hours will be Monday-Friday 6:30 AM-6 PM. .

LPA began the tour of the facility with applicant beginning at the front entrance/office to the facility where the parents will enter and exit from the parking lot of Paramount Street. The children sign in/out for the parents is located at the entrance of class room #1, using an Ipad. The parent board is located in the entrance of class room #1 with all the licensing required postings and are visible for all to see. Facility has telephone service and phone number to the school was verified. Temperatures and health checks and use of hand sanitizer will be conducted and used at the entrance of class room #1. The ill/isolation area is located in the staff lounge where the staff rest room is located and is next door to the Directors/main office. A cot and chair is located in the ill isolation area for a child to rest if needed.

LPA was guided through the Preschool class rooms #1 and 2 where LPA observed, toys and play equipment to be age appropriate clean and safe. Fixtures, furniture and equipment was inspected for age appropriateness and is in good repair. LPA observed the facility has central heat and air, overhead lights as well as natural light.
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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/27/2023
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: AZUSA MONTESSORI ACADEMY
FACILITY NUMBER: 198021233
VISIT DATE: 06/27/2023
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LPA observed a bathroom in room #1 with 2 toilets and 2 sinks and in class room #2 has 1 toilet and 1 sink. All are in good condition, water temperature, paper towels, toilet paper, and all were inspected for safety, sanitation and operable. (3 toilets = capacity of 45 and 3 sinks = capacity of 45 children).

Napping equipment (cots) were inspected and observed to be in good condition. Cots are stored in class room #1. The parents will provide blankets/sheets and will take home at the end of each week to wash. Appropriate Individual storage space was observed to be available for each child and cleanliness was observed in the room. The children will be provided jugs of water and disposable cups and they can bring their own labeled water bottles/Sippy cups. Breakfast, Lunch and AM/PM snack will be provided and prepared by the facility. Menus were observed posted. Containers used to discard food have tight fitting lids. Facility has extra linen and food available if needed.

Child care centers shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well being of children, employees and visitors.

The facility has a kitchen/food pre area in another area so children do not have access. LPA observed a refrigerator and large counter tops for use of food preparation in this area. Space was inspected for safety and cleanliness. The applicant will take measures to keep the facility free of flies, other insects and rodents.

Carbon monoxide detectors and smoke detectors are present and are in operable condition in the class room. Smoke and Carbon Monoxide detectors should be checked and batteries replaced as needed. The fire extinguisher type 2A-10BC (Service date 05/02/2023) must be serviced annually or as often as necessary. Fire and earthquake drills must be done every 3 months and documented. Hazardous items including disinfectants, poisonous, cleaning solutions and any other items that could pose a danger to children were observed to be stored inaccessible to children.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2023
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: AZUSA MONTESSORI ACADEMY
FACILITY NUMBER: 198021233
VISIT DATE: 06/27/2023
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Licensing staff was then guided to the preschool outdoor play area which is located right outside class room #1. The yard is self contained by a gate around it for separation from other church areas. Water jugs with disposable cups will be used for children while outdoors. LPA observed age appropriate outdoor toys, play equipment and materials to be clean, safe and in good repair, as well as adequate shade available by use of the building. trees and gazebo. All areas around play equipment and slides are cushioned with material to absorb a fall. LPA advised the applicant that the children need to be within the direct care and supervision, including visual observation and supervision of the teacher(s) at all times. No bodies of water were observed on the premises.

Facility has no transportation policy for preschool children. Applicant states that any lifesaving medication will be stored in a locked area inaccessible to children in care. First aid supplies were observed to have all the required items including a thermometer. There is a fully equipped first aid kit available in each class room.

Items discussed during this Inspection:


Criminal Records clearance: Applicant was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated
Licensing does not tolerate the following: Refused Entry to a Facility or Any Part of a Facility is a
violation of Section 1596.852, 1596.853 or 1597.09. Regulations 101238 (g) (2), The Presence of an Excluded Individual, Fire Clearance Violations, Accessible Bodies of Water, Accessible Firearms, Ammunition or Both. Continue on page 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2023
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: AZUSA MONTESSORI ACADEMY
FACILITY NUMBER: 198021233
VISIT DATE: 06/27/2023
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Page 4 Continued Items discussed during this Inspection:

Pediatric First Aid and CPR: At least one person in the facility, along with the Director/Administrator must be trained in Pediatric First Aid and CPR and present in the facility.
Current Children’s Roster LIC 9040: Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician. This children roster must be updated and available to the licensing agency upon request.
Designated Staff: The name of the childcare center director or fully qualified teacher(s) designated to act in the director's absence must be on file.
Qualifications and staff files: Educational background, training, and/or experience and all required documents by the department for each staff present must be available for review.
Children’s Records: All required licensing documents must be available for review; including but not limited to, the following: Name, address and telephone number of the child's authorized representative and of relatives or others who can assume responsibility for the child if the authorized representative cannot be reached when necessary. Visit www.shotsforschool.org for immunization information.
Immunization Requirements: Commencing September 1, 2016, a person shall not be employed or
volunteer at a day care center if he or she has not been immunized against flu, pertussis, & measles.
Breakfast/Lunch/Snack Menus: Menus are required to be posted one week in advance where it is visible by the child's authorized representative. Menus for the past 30 days must also be available upon request.
Reporting Requirements Section 101212: Changes at the facility must be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your location. The Director was also advised of the requirement to report Unusual Incidents and/or injuries to the parent/guardian and to CCL within the time frame specified by the regulation.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2023
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: AZUSA MONTESSORI ACADEMY
FACILITY NUMBER: 198021233
VISIT DATE: 06/27/2023
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LPA reviewed with applicant the LIC 311A, Records to be maintained at the facility, for child's records, personnel records, administrative records, and documents to be posted. LIC 311A given on this date

Update: Effects of Lead Exposure and the following Provider Information Notices (PINs) Required Lead Testing: PIN 20-01 CCP Effects of Lead Exposure, and Guardian User Account Access - PIN 20-20-CCLD. were discussed



Incidental Medical Services (IMS): This facility plans to provide Incidental Medical Services.- IMS. For IMS information, For IMS information see PIN 22-02- CCP. A Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (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.

MyChildCarePlan.org – Applicant, was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.

To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2023
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: AZUSA MONTESSORI ACADEMY
FACILITY NUMBER: 198021233
VISIT DATE: 06/27/2023
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Applicant’s email address was verified/obtained during this inspection. The applicant was advised that the email may be public information. (Email: rachel@montessoriofla.com).

Measurements taken allows for a capacity of 32 preschool children in class room #1 and a capacity of 11 in class room #2. (Short side cap 5, Long side cap 6)



Measurements were taken of the outdoor play yard and the total outside capacity allows for 153 preschoolers

Applicant is requesting a capacity of 46 preschool children. Based on LPA measurements taken and observations of the facility, the measurements allow for the 43 preschool children indoors and 153 outdoors. Fire clearance is on file and approved for the requested capacity of 46 preschool children.



Applicant will be licensed for 45 preschool children. Facility will be licensed once final file review.

Exit interview conducted and report was reviewed with the applicant Rachel Cordova .

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2023
LIC809 (FAS) - (06/04)
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