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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334843214
Report Date: 09/27/2023
Date Signed: 09/27/2023 12:16:09 PM

Document Has Been Signed on 09/27/2023 12:16 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:SUNNYMEAD MONTESSORI SCHOOLFACILITY NUMBER:
334843214
ADMINISTRATOR:TILLEKERATNE, DELRINEFACILITY TYPE:
850
ADDRESS:24851 BAY AVENUETELEPHONE:
(951) 924-1425
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 19DATE:
09/27/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:41 AM
MET WITH:Delrine TillekeratneTIME COMPLETED:
12:22 PM
NARRATIVE
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On September 27, 2023, at 11:41 AM, Licensing Program Analyst (LPA) Anastasia Flores, arrived to conduct an investigation in regard to allegations submitted in our office on 9/18/23. During investigation, LPA requested documents from Director, Delrine Tillekeratne, such as child roster (LIC9040) and also staff roster (LIC500).
The director stated she will have to go home and update the records and email to LPA this evening. LPA asked Ms. Delrine for the current roster she has on file right now as of 9/27/23, she stated she does not have one available and has not had time to update the current roster.

Due to documents not being provided or kept up to date at time of inspection, facility is being cited for Title 22 Regulations, CCR101221(a) Child's Records.

An exit interview was conducted and appeal rights and notice of site visit was handed to Director, Delrine Tillekeratne.

A Notice of Site Visit was issued, and LPA verified that it was posted in a prominent location at the facility before leaving. The Licensee understands that it must remain posted for the next 30 days.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Anastasia Flores
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2023
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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Document Has Been Signed on 09/27/2023 12:16 PM - It Cannot Be Edited


Created By: Anastasia Flores On 09/27/2023 at 12:05 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
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: SUNNYMEAD MONTESSORI SCHOOL
FACILITY NUMBER: 334843214

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/28/2023
Section Cited
CCR
101221(a)

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101221(a) childrens records: (a) A separate, complete and current record for each child is maintained in the child care center.
this was not met as evidenced by...
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Director will update her children's roster and send a copy to LPA Flores via email no later then 9/28/23
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Based on interview and record review, the director did not have a current and updated children's roster. This posed a potential health, safety or personal rights risk to persons 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:Pauline Beschorner
LICENSING EVALUATOR NAME:Anastasia Flores
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2023


LIC809 (FAS) - (06/04)
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