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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371633
Report Date: 12/18/2024
Date Signed: 12/18/2024 04:42:26 PM

Document Has Been Signed on 12/18/2024 04:42 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:ROBIN HOOD MONTESSORI SCHOOLFACILITY NUMBER:
304371633
ADMINISTRATOR/
DIRECTOR:		SURAVARAPU, SELINAFACILITY TYPE:
850
ADDRESS:27500 MARGUERITE PARKWAY # 6TELEPHONE:
(949) 364-6342
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92692
CAPACITY: 47TOTAL ENROLLED CHILDREN: 47CENSUS: 29DATE:
12/18/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:00 PM
MET WITH:DirectorTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
NARRATIVE
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Licensing Program Analyst (LPA), Mahnaz (Nancy) Malek conducted an onsite inspection for the purpose of case management- Deficiencies. LPA met with Director, Shelina Suravarapu. LPA observed 12 awake preschool children with 2 staff in Rainbow Room, and 17 awake children with 3 staff in Fulbright Room.

During the course of an investigation, LPA found out that one staff person, Maria Sagers worked at the facility on 11/22/2024 and staff, Veronica Rodriguez worked at the facility on 11/25/2024, 11/26/2024, and 11/27/2024 as substitute staff without being associated to the facility. These two staff had clearance ID numbers on file but were not associated.

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 except for Maria Sagers and Veronica Rodriguez. These two staff had clearance ID numbers on file but were not associated. A civil penalty of $300.00 for 3 days for Veronica Rodriguez and $100.00 for Maria Sages were assessed today.

The facility representative, Shelina Suravarapu was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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.
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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE: DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/18/2024
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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: ROBIN HOOD MONTESSORI SCHOOL
FACILITY NUMBER: 304371633
VISIT DATE: 12/18/2024
NARRATIVE
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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communications.

The facility representative, Shelina Suravarapu was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301(voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at:https://www.ada.gov/resources/child-carecentershttps://www.ada.gov/resources/child-carecenters


A notice of site visit was given to facility representative, Shelina Suravarapu and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

In the areas that were evaluated, the following deficiency of the California Code of Regulations, Title 22, Division 12 Section 101170(e)(2) was cited on this inspection date. Please refer to LIC 809D for details of deficiency.



Exit interview conducted and report was reviewed with the facility representative, Shelina Suravarapu.

End of report

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/18/2024 04:42 PM - It Cannot Be Edited


Created By: Mahnaz Malek On 12/18/2024 at 04:01 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: ROBIN HOOD MONTESSORI SCHOOL
FACILITY NUMBER: 304371633

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/20/2024
Section Cited
CCR
101170(e)(2)

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101170(e)(2) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: Request a transfer of a criminal record clearance as specified in Section 101170(f)

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The director stated those two staff don't work at the faciliy any longer. The director agreed to send an acknowledgment letter stating she is aware of this section of Title 22 Regulation, The statement will be sent to LPA's email address by the due date of 12/20/2023
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This requirement was not met as evidenced by staff Maria Sagers and Veronica Rodriguez were not associated to the facility when working as substitutes on 11/22, 11/25, 11, 26, and 11/27/2024. Civil penalty was assessed.
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A civil penalty of $300.00 for 3 days for Veronica Rodriguez and $100.00 for Maria Sages were assessed today.

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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:Thuy Ho
LICENSING EVALUATOR NAME:Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:
DATE: 12/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/18/2024


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