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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300606752
Report Date: 06/11/2024
Date Signed: 06/11/2024 04:11:10 PM

Document Has Been Signed on 06/11/2024 04:11 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:MONTESSORI ON THE LAKEFACILITY NUMBER:
300606752
ADMINISTRATOR/
DIRECTOR:		EVEREST, JULIEFACILITY TYPE:
850
ADDRESS:24291 MUIRLANDS, SUITES 1 & 2TELEPHONE:
(949) 855-5630
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY: 77TOTAL ENROLLED CHILDREN: 77CENSUS: 54DATE:
06/11/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Lauren SillsTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On 6/11/24, Licensing Program Analyst (LPA), Christine Jung conducted an onsite inspection for the purpose of an Annual Inspection. Upon arrival, LPA was led on a tour by facility representative Lauren Sills. Sills was stepping in while the Director was on vacation. The overall census observed was 9 preschool staff and 54 preschool children. Facility hours are 7a.m.- 6p.m., Monday through Friday.

The Facility Personnel Report Summary reviewed on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee was reminded that all adults 18 and over, 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.

During the inspection, items which could pose a danger to children (detergents, cleaning compounds, and medications) were observed to be inaccessible to children. Poisons/Hazardous Items are not kept on the premises. Food is not prepared on site; children pack food from home and stored properly until mealtimes. Floors, equipment, and furniture were clean, observed to be in good repair, and free of sharp edges. There was drinking water available, both indoors and outdoors, to children by refillable bottles labeled with the children’s name. The children's restrooms were clean and sanitary. Children nap on cots, bedding was stored individually, and taken home weekly to be washed by parents at end of week. The facility conducted an earthquake emergency drill on 10/19/2023. The facility had a working carbon monoxide detector. Facility met all posting requirements.

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SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Soo Jin Jung
LICENSING EVALUATOR SIGNATURE: DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/11/2024
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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MONTESSORI ON THE LAKE
FACILITY NUMBER: 300606752
VISIT DATE: 06/11/2024
NARRATIVE
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4 staff files were reviewed. There was a separate record for each staff. 3 out 4 staff files did not have current Mandated Reporter Training Certificates. See LIC 809D for deficiencies cited.

5 children files were reviewed. There was a separate record for each child. 1 out of 5 children file did not have tuberculosis result. Sign in/out procedure was reviewed for compliance. The facility uses Procare for authorized representatives to sign in and out. The person who signs the child in and out uses their full legal signature and records the time of day.

The outdoor activity space was inspected for compliance and was enclosed by a fence. The surface of the outdoor activity space was maintained and free of hazards. The cushioning materials sand and rubber mats commercially produced for the purpose around the climbing equipment, slides, and other similar equipment were sufficient to absorb falls. The outdoor equipment and toys were in good repair.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). The facility did not complete testing prior to their deadline, in accordance with the Written Directives outlined in PIN 21-21.1-CCP. The facility purchases all drinking water from an outside vendor (Wateria) and does not prep food on-site. LPA referred facility representative to PIN 21-21.1-CCP so that lead testing can be completed. See LIC 809D for deficiency cited.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated 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)/ (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

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SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Soo Jin Jung
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
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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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MONTESSORI ON THE LAKE
FACILITY NUMBER: 300606752
VISIT DATE: 06/11/2024
NARRATIVE
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The facility representative was informed that Licensing Quarterly Updates are available at www.ccld.ca.gov Facility representative may request to be added to an email list to receive a Quarterly Update by contacting the Child Care Advocate at childcareadvocatesprogram@dss.ca.gov or at www.ccld.ca.gov
LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian


Based on LPAs observations, record reviews, and interview, the following violations were observed and are being cited in accordance with California Code of Regulations, Title 22, Division 12, Chapter 1. See LIC 809D for violations cited: 5 Type B, 1 TV.

A notice of site visit was given and must remain posted for 30 days. Failure to post will result in a Civil Penalty of $100.00.

Exit interview conducted and report was reviewed with the facility representative Lauren Sills.

End of Report.
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Soo Jin Jung
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
LIC809 (FAS) - (06/04)
Page: 3 of 7
Document Has Been Signed on 06/11/2024 04:11 PM - It Cannot Be Edited


Created By: Soo Jin Jung On 06/11/2024 at 01:28 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MONTESSORI ON THE LAKE
FACILITY NUMBER: 300606752

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/11/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
WD
101700(b)
Written Directives for Lead Testing
(b) All licensed Child Care Centers operating in buildings constructed before January 1, 2010, shall test their water for lead pursuant to these written directives.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on observation, interview, record review, the licensee did not comply with the section cited above in that 1 out 1 lead testing was not completed, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/09/2024
Plan of Correction
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Facility representative stated that they will complete the lead testing by due date and submit results to LPA.
Type B
Section Cited
HSC
1596.8662(c)
Administration of Child Day Care Licensing
(c) Current proof of completion for each licensed child day care provider or applicant for that license, administrator, and employee of a licensed child day care facility shall be submitted to the department upon inspection of the child day care or upon request by the department.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in 3 out of 3 staff did not have current mandated reporter training certificates, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/18/2024
Plan of Correction
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Facility representative stated that they will submit current mandated reporter training certificates to LPA by due date.
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:Martha Malane
LICENSING EVALUATOR NAME:Soo Jin Jung
LICENSING EVALUATOR SIGNATURE:
DATE: 06/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/11/2024


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Document Has Been Signed on 06/11/2024 04:11 PM - It Cannot Be Edited


Created By: Soo Jin Jung On 06/11/2024 at 01:28 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MONTESSORI ON THE LAKE
FACILITY NUMBER: 300606752

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/11/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) 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 influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in 4 out 4 staff did not have updated influenza vaccinations or statement to decline, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/25/2024
Plan of Correction
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Facility representative stated that they will submit proof of influenza or statement to decline for all staff to LPA by due date.
Type B
Section Cited
CCR
101217(a)(12)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (12) Tuberculosis test documents as specified in Section 101216(g).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in 1 out of 1 staff did not have TB results on file, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/25/2024
Plan of Correction
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Facility representative stated that they will submit proof of influenza or statement to decline for all staff to LPA by due date.
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:Martha Malane
LICENSING EVALUATOR NAME:Soo Jin Jung
LICENSING EVALUATOR SIGNATURE:
DATE: 06/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/11/2024


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Document Has Been Signed on 06/11/2024 04:11 PM - It Cannot Be Edited


Created By: Soo Jin Jung On 06/11/2024 at 01:39 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MONTESSORI ON THE LAKE
FACILITY NUMBER: 300606752

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/11/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216.3(a)
There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance, except as specified in (b) and (c) below.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in that 1 out 1 staff was not associated to the facility, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/12/2024
Plan of Correction
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Facilty representative stated that they will ensure that staff is associated to the facility by the due date and send proof of associate to LPA.
Section Cited
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:Martha Malane
LICENSING EVALUATOR NAME:Soo Jin Jung
LICENSING EVALUATOR SIGNATURE:
DATE: 06/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/11/2024


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