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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371527
Report Date: 09/14/2021
Date Signed: 09/14/2021 01:18:29 PM

Document Has Been Signed on 09/14/2021 01:18 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:HERITAGE MONTESSORI SCHOOLFACILITY NUMBER:
304371527
ADMINISTRATOR:LEE,M SHALANEFACILITY TYPE:
850
ADDRESS:15881 GOLDENWEST STREETTELEPHONE:
(714) 891-9921
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92647
CAPACITY: 59TOTAL ENROLLED CHILDREN: 0CENSUS: 39DATE:
09/14/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Administrator Ms, Lee M ShalaneTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Ms. Ketki Desai conducted an announced on site pre-licensing inspection at the childcare center. It is a Change of Ownership. Facility was given an Emergency Approval to Operate which is valid up to September 29th 2021.
LPA met with Facility Administrator Ms. Lee Shalane, who gave a tour of the Child Care Center. The applicant has requested to provide care and supervision for 59 Preschool age children (2- 5 years Monday through Friday 7.30 am. to 5.30 PM. in the assigned two classrooms. Due to COVID 19, LPA observed staff wearing face mask, social distancing and following CDC and Dept of Public Health Guidelines.

A review of the Facility Personnel Report Summary 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.

The facility has an Elementary school on the same premises, which is held on the first level of the center, the stairway leading to the first level is in front of the Director's office in the passage area and the stairway is made inaccessible by having a safety barrier and preschool children have a separate entrance from the back side of the facility. Due to current pandemic situation, Parents are encourage to follow CDC and COVID requirements, children are dropped off and picked up at the curb end (Back side of the facility) upon entrance of the car into the building area, staff checks the temperature of the child, a visual check in done, parents sign off the children manually before the child is handed over to the teacher, who walks the child into the classroom. Hand washing activity is completed before the child engages in other classroom activities.
Initially before COVID, children were received in the front area ( across the DIrector's office) and children would enter through the designated classroom but now as they are dropped out at the curb end, children walk through the classroom. Parents are encouraged to remain outside. The office area is located in front of the main entrance door of the facility, adjoining to it is the kitchen area and designated Staff room and adult restroom. (Page-1)
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: HERITAGE MONTESSORI SCHOOL
FACILITY NUMBER: 304371527
VISIT DATE: 09/14/2021
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Medication will be stored in Kitchen area in a locked glass cabinet (Outside the classroom door) and shall be administered by the teacher or the Facility in charge, emergency First Aid kits are stored in the classrooms and are hung on the wall for immediate access. Medication administration forms were reviewed.
Isolation area is the Director’s office and the sick child shall use the adult restroom located in the Staff rest area, there an additional mat and linens for the sick child.

The following were inspected in the indoor activity space:
· Classrooms are adequately equipped with age and size appropriate furniture and equipment
· Drinking water is available inside through personal water bottles including water pitchers in each rooms
· Sign in/Sign out procedure was reviewed and meets regulation requirements (Manual sign in and out)
· There is a working smoke detector, carbon monoxide detector and fire extinguisher that meet statutory requirements.
· Cubbies available for storage of individual child’s personal belongings and/or bedding
· Napping equipment: Mats are used and are stored at the end of the classroom, napping linens and blankets are provided by parents and are taken home daily for the washes
· Facility shall provide Two snacks and a late evening snack, Lunch is provided by the parents.
Kitchen was observed to clean, free of insects or pests. There one refrigerator and one freezer, where snacks are stored

LPA discussed the posting requirements including, but limited to, the following:
· Facility License in public area (101160)
· Emergency Disaster Plan (LIC 610) /
Earthquake Preparedness Check List (LIC 9148)
· Parents’ Rights Poster (PUB 393) / Personal Rights (LIC 613A)
· Menus / Activity Schedule
· Notice of Site Visit (LIC 9213) and Type A deficiencies / Plan of Corrections of Type A deficiencies
· Granted Waivers (available for review)
· Child Car Seat Law (PUB 269) and COVID Posters

(Page-2)
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
LIC809 (FAS) - (06/04)
Page: 2 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: HERITAGE MONTESSORI SCHOOL
FACILITY NUMBER: 304371527
VISIT DATE: 09/14/2021
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Facility has several operating options : Morning care : 7.30 am to 8.40 am (Monday to Friday)
Five full day sessions : 9.00 am to 2.30 PM / Half Day sessions : 9.00 am to 12.00 PM / Three day Full day sessions and Extended evening care : 2.30 PM to 5.30 PM (Evening snack shall be provided by the facility)

On today's inspection, LPA measured Indoor and Outdoor areas used by the children.
Indoor measurements:
Room # 1: 39'58 X 37'33 = 1477'52
Room # 2: 39'58 X 37'08 = 1467'62

Total indoor area : 2945'14 divided by 35= 84'15 (84 children)

Total sinks: 6 X 15= 90 (children) / Total Toilets: 4 X 15= 60 (children)
There are sufficient toilets and sinks in the facility to meets the needs of the requested capacity for 59 children

Toilets and sinks were observed to be age appropriate. Bathrooms were clean and accessible to children. Each classrooms has two sinks and two toilets in the bathroom and one sink was observed in each classroom. There is changing table in bathroom designated for classroom # 1.

Outdoor Yard:
The following were inspected in the Outdoor activity space;
· Playground is fully enclosed by an appropriate fencing
· Drinking water is available outdoors by water pitchers with small disposable cups/ Water fountain/ Personal Water bottles
· Outdoor activity space is supplied with age and size appropriate equipment, including climbing play structures and outdoor activity toys,
· An adequate amount of cushioning material consisting artificial grass is placed through the entire yard
· Adequate shade is provided by shaded structure (Canopy)and benches are placed.
· Each classrooms have their own entrance leading into their yards.
Facility has requested a Waiver for a Shared yard with Staggered schedule for Preschool children to share yard with the Elementary school on the premises. (Page -3)
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: HERITAGE MONTESSORI SCHOOL
FACILITY NUMBER: 304371527
VISIT DATE: 09/14/2021
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Outdoor yard measurements

Shared yard/elementary
74.42
50.17
3733.65
 3733.65
Yard with Structures
86
35.75
3074.50
 3074.50
Small yard room # 1
39
26.33
1026.87
98.11
 928.76
small lunch area
40
9.83
393.20
 393.20

Total outdoor space: 2945'14 Sq Feet divided by 75= 84'15 (84 children)

Based on the indoor and outdoor measurements, sink and toilet availability, facility has enough space to accommodate the requested 59 Preschool children ( 2-5 years old) in the assigned two classrooms.

Fire clearance received from Huntington Beach Fire Services dated 7/17/21 have approved the requested capacity of 59 Preschool age children in the assigned two rooms.

Facility Administrator is current on the required Immunization/ Pediatric CPR/ First training valid through
8/22/22 and have provided the completion certificate for the Preventive Health training (Nutrition and Lead component)

Water Analysis has been completed by the facility and the report is on file.

LPA discussed with the applicant that all employees must have criminal record clearances associated to the facility prior to their presence in the facility, staff to child ratio requirements, direct visual supervision requirements, emergency/disaster drills, children records, mandated reporter training, and staff immunization requirements against measles, pertussis, and influenza. Applicant was advised the children's bedding must be stored individually and may not touch another children's bedding.

The applicant was given a pamphlet on Lead Exposure and was discussed with provider. Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org. The Chaptered Legislation for AB 2084 (Nutritious Beverages) is available to view on the website at: http://ccld.ca.gov/res/pdf/12APX-11.pdf
(Page-4)
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: HERITAGE MONTESSORI SCHOOL
FACILITY NUMBER: 304371527
VISIT DATE: 09/14/2021
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Applicant was informed of Mandated Reporter Training for self and all assistants. Department web site form was given to down load forms, Title 22 regulations, and training's on-line at www.ccld.ca.gov. The applicant was also informed to visit the website for Quarterly Updates. The applicant was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: 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.
Facility Director has access to the new system.

Information on the additional nutrition training, immunization requirements for children, and Health Schools Act (http://www.cdpr.ca.gov/docs/pestmgt/schoolipm.htm) were provided. The applicant/facility representative was informed, and website given, about the California Child Care Disaster Plan has been posted to the UCSF California Childcare Health Program website: cchp.ucsf.edu/content/disaster-preparedness

Incidental Medical Services : This facility plans to provide the services. IMS plan was submitted and
LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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

The facility was following Title 22 requirements at the time of the inspection. Based on today’s Indoor and Outdoor measurements, sink and toilet availability, this center has enough activity space to support the capacity of 59 Preschool children, ages 2-5 years old in the two assigned rooms.

A license will be issued for the capacity of 59 preschool children age 2-5 years old, after a final review. The applicant will be notified if any additional information is required. (Page-5)
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: HERITAGE MONTESSORI SCHOOL
FACILITY NUMBER: 304371527
VISIT DATE: 09/14/2021
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Applicant was also advised, once licensed, the Notice of Site Visit must be posted for 30 days and if A violations are cited then the Licensing Report (LIC809 or 9099) must be posted by the Notice of Site Visit for a period of 30 days or $100 civil penalties will be assessed, and the report shall posted and copies provided to the parents/guardians of the children in care at the facility by the next business day,and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file.

An exit interview was completed.

The report was reviewed and discussed.

Appeal Rights were discussed. The applicant was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Licensing office within 15 business days.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
LIC809 (FAS) - (06/04)
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