304371414-3-29-2023-06-CC-DTHN-CQDV2B-20230329160249

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371414
Report Date: 03/29/2023
Date Signed: 03/29/2023 04:02:54 PM

Document Has Been Signed on 03/29/2023 04:02 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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	MISSION VIEJO MONTESSORI		FACILITY NUMBER:	304371414
ADMINISTRATOR:	YANEZ, MIRIAN		FACILITY TYPE:	830
ADDRESS:	23581 MADERO # 108		TELEPHONE:	(949) 770-1093
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY: 28	TOTAL ENROLLED CHILDREN: 13	CENSUS: 6	DATE:	03/29/2023
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	02:20 PM
MET WITH:	Mirian Yanez		TIME COMPLETED:	04:20 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) Dean Thompson conducted an unannounced case management incident inspection in response to a self reported Unusual Incident dated 3/27/2023. LPA met with Director Mirian Yanez and toured the facility. LPA observed 6 infants and two staff. A review of the Facility Personnel Report Summary 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. During the visit, it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. On 3/27/2023 a self reported Unusual Incident Report (UIR) was filed with the Licensing Office. The facility reported a child being left unattended without any supervision inside the infant classroom (Butterfly) dated 3/23/2023. LPA was able to review camera footage on 3/29/2023. LPA observed two staff walking out of the Butterfly classroom at 3:04 PM and leaving child (C1) unattended. LPA was unable to determine how long child (C1) was unsupervised due to a glitch in the recorded video footage provided by the facility. Director stated staff were made aware child (C1) was left alone inside the butterfly classroom once the parent arrived for pick up at 3:07 PM. Parent arrival time was confirmed by the sign in/sign out app ProCare. On 3/29/2023 LPA interviewed the parent of child (C1) who stated observing the child alone at approximately 3:09 PM. Continue to page 2

SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Dean Thompson
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023

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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MISSION VIEJO MONTESSORI	FACILITY NUMBER: 304371414
	VISIT DATE: 03/29/2023

NARRATIVE

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Based on LPA observation and statements, it was revealed that child (C1) was left alone on 3/23/2023 without any adult supervision inside the Butterfly classroom. The child was left unattended for about 3 - 5 minutes until parent of child (C1) arrived. The following violation Responsibility for providing care and supervision was revealed today and is being cited in accordance with California Code of Regulations, Title 22, Division 12, Chapter 1, 101229 (a)(1) . Please see the attached LIC 809D.

LPA Thompson informed Director Mirian Yanez that this report dated 3/29/2023 document(s) one Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Thompson informed Director Mirian Yanez to provide a copy of this licensing report dated 3/29/2023 that documents any Type A citation(s) 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. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with Director Mirian Yanez. 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.

Appeal Rights and deficiencies were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days.

SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Dean Thompson
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/29/2023 04:02 PM - It Cannot Be Edited

Created By: Dean Thompson On 03/29/2023 at 03:25 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: MISSION VIEJO MONTESSORI	FACILITY NUMBER: 304371414
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/29/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 04/12/2023 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time.... Supervision shall include visual observation.	1 2 3 4 5 6 7	Director agreed to conduct a training for the staff in relation to Responsibility for Providing Care and Supervision and will watch the Department Training video related to Providing Care and Supervision on the Department website at www.ccld.ca.gov. A sign in sheet will be provided to the Department related to the training discussion and the attendees by the due date 4/12/23.
	8 9 10 11 12 13 14	Based on LPA observation and statements, it was revealed that child (C1) was left alone on 3/23/2023 without any adult supervision inside the Butterfly classroom. The child was left unattended for about 3 - 5 minutes until parent of child (C1) arrived.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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:

Judy Hanson

LICENSING EVALUATOR NAME:

Dean Thompson

LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023

LIC809 (FAS) - (06/04)

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