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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300606752
Report Date: 09/06/2024
Date Signed: 09/13/2024 11:16:52 AM

Document Has Been Signed on 09/13/2024 11:16 AM - 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: 33DATE:
09/06/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:35 AM
MET WITH:Director Julie EverestTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
NARRATIVE
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*This is an amended version of an original report dated 9/6/24.*
On 9/6/2024 at 10:35AM, Licensing Program Analyst (LPA), Christine Jung, conducted an unannounced case management-deficiency inspection in response to an incident that was self-reported to the Department. LPA met with Director, Julie Everest, and was led on a tour of the facility. There were 33 children and 8 staff members present. Hours of operation are Monday through Friday 7:00am to 6:00pm.

Director stated that on 9/5/2024, Staff 1 (S1) and Staff 2 (S2) were lining up with their class on the outdoor play yard to return to their classroom. S1 and S2 were counting the number of children and noticed that one child was not present. S1 went into the classroom to look for C1 but did not see them. S1 looked in the classroom restroom, but did not see C1. S1 looked through the windows leading into the office and saw C1 through the windows being walked to the facility from the parking lot by Adult 1 (A1) who is not a member of facility staff. S1 stated they composed themselves and walked out to retrieve C1. S1 stated they do not recall A1 making any statements. S1 stated they did not converse with A1, instead was focused on C1.

Director stated they were completing the Unusual Incident Report and would submit the written report to the Department by end of business day 9/6/2024. The facility director reported the incident to the Department in a timely manner. Based on the information obtained and interviews conducted, one Type A citation for Absence of Supervision is being cited on the LIC809D.

LPA informed Director, Julie Everest, that this report dated 9/6/2024 documents 1 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 informed Director to provide a copy of this licensing report dated 9/6/2024 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.
(Go to Page 2)
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Soo Jin Jung
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2024
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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MONTESSORI ON THE LAKE
FACILITY NUMBER: 300606752
VISIT DATE: 09/06/2024
NARRATIVE
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 A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Due to technical difficulties, LPA emailed the report to the director.



A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director, Julie Everest.
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Soo Jin Jung
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/06/2024 11:28 AM - It Cannot Be Edited


Created By: Soo Jin Jung On 09/06/2024 at 10:52 AM
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: 09/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/06/2024
Section Cited
CCR
101229(a)(1)

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101229(a)(1) Responsibility for Providing Care and Supervision: 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:
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Director met with staff to review supervision procedures, will post signs on doors to remind staff and parents to ensure doors are closed, and will ensure a staff member is stationed at the front office at all times.
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Based on interviews and record reviews, the licensee did not ensure visual supervision was provided at all times, which poses an immediate risk to the health, safety, and personal rights of the clients 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:Martha Malane
LICENSING EVALUATOR NAME:Soo Jin Jung
LICENSING EVALUATOR SIGNATURE:
DATE: 09/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/06/2024


LIC809 (FAS) - (06/04)
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