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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270699
Report Date: 01/14/2025
Date Signed: 01/16/2025 09:52:28 AM

Document Has Been Signed on 01/16/2025 09:52 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:CYPRESS MONTESSORI ACADEMYFACILITY NUMBER:
304270699
ADMINISTRATOR/
DIRECTOR:
RUIZ, REBECCAFACILITY TYPE:
850
ADDRESS:8622 LA SALLETELEPHONE:
(714) 826-0800
CITY:CYPRESSSTATE: CAZIP CODE:
90630
CAPACITY: 33TOTAL ENROLLED CHILDREN: 33CENSUS: 23DATE:
01/14/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:20 PM
MET WITH:Director Jatauriia Rodriquez TIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) Patricia Duron conducted a case management investigation for the incident that the facility self-reported to licensing office on 12/18/2024 According to the incident report, the incident occurred on 12/17/24 at approximately 12:15pm. The director reported, Child 1 (C1) stated to parent that Staff #1 (S1) and Staff #2 (S2) touched C1 in the bathroom.

LPA met with Director and census was taken. LPA observed 4 staff including the director with 23 preschool age children. A review of staff criminal clearance records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During today's inspection LPA Duron reviewed files and interviewed 3 staff members.

Director stated S1 or S2 do not physically assist children while using the restroom per facility's policy. S1 stated, staff stand by the restroom to supervise the children but do not enter the restroom while children are using the restroom. S1 stated, the children in the 4's room use the restroom on their own. If needed they will change their clothes on their own, staff will verbally guide them and verbally assist children. S1 stated, staff encourage children to be independent and children wipe and clean themselves on their own, S2 stated, per policy staff do not physically assist children while using the restroom. S2 stated, staff will stand on the outside of the restroom while a child is using the restroom.

During today's staff interviews, 3 out of 3 staff stated they have never witnessed S1 or S2 assist C1 with the restroom, and have not witnessed S1 or S2 touch C1 in the bathroom.

Director stated, the staff will continue to follow facility's bathroom policy, and supervise children while standing on the outside of the restroom while children are using restroom. Staff will verbally encourage and assist children when using the restroom.
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Patricia Duron
LICENSING EVALUATOR SIGNATURE: DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2025
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: CYPRESS MONTESSORI ACADEMY
FACILITY NUMBER: 304270699
VISIT DATE: 01/14/2025
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In the areas that were evaluated, no deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit.

An exit interview was completed. Appeal Rights and deficiencies were discussed. A copy of the Appeal Rights was given to the facility representative. All appeals must be in writing and received by the Licensing office within 15 days.

The Director was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The notice of site visit was posted on the door.
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Patricia Duron
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025
LIC809 (FAS) - (06/04)
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