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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300575
Report Date: 12/04/2023
Date Signed: 12/04/2023 12:17:26 PM

Document Has Been Signed on 12/04/2023 12:17 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:BRIGHT MINDS MONTESSORI,INC.FACILITY NUMBER:
336300575
ADMINISTRATOR:AURORA GONZALEZFACILITY TYPE:
850
ADDRESS:17159 GRAND AVETELEPHONE:
(951) 378-4103
CITY:LAKE ELSINORESTATE: CAZIP CODE:
92530
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 12DATE:
12/04/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Nam De SilvaTIME COMPLETED:
11:30 AM
NARRATIVE
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On December 4, 2023 at 10:00 am Licensing Program Analyst (LPA) Jessica Rubio conducted a Case Management inspection to follow-up on the compliance plan. LPA met with Director Leslie Marquez and Licensee Nam De Silva. LPA toured the facility and took a census of the children in care. LPA observed 12 children in care with one teacher providing care and supervision. In addition, LPA reviewed two staff files to ensure the staff met minimum qualifications for the positions in which they were hired. Two staff were missing documentation of one or more immunizations and one staff was missing a TB test. Citations will be issued.

The facility is being cited for Health & Safety Code and Title Regulations. See LIC 809D for cited deficiencies.
Exit interview conducted and report was reviewed with and provided to Licensee Nam De Silva. Appeal rights were also provided. A notice of site visit was given and must remain posted for 30 days in location visible to all parents entering the facility. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Jessica M Rubio
LICENSING EVALUATOR SIGNATURE: DATE: 12/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/04/2023
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 12/04/2023 12:17 PM - It Cannot Be Edited


Created By: Jessica M Rubio On 12/04/2023 at 11:38 AM
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: BRIGHT MINDS MONTESSORI,INC.
FACILITY NUMBER: 336300575

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/25/2023
Section Cited
HSC
1596.7995(a)(1)

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(a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
This requirement was not met as evidenced by:
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Licensee stated that he would get documentation on file and provide proof of immunizations to LPA
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Based on record review, two staff were missing documentation of required immunizations, which poses a potential health, safety and/or personal rights violation to persons in care.
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Type B
12/25/2023
Section Cited
CCR101216(g)(1)

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(g)..(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.
This requirement was not met as evidenced by:
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Licensee stated documentation would be on file and proof provided to LPA.

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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:Jessica M Rubio
LICENSING EVALUATOR SIGNATURE:
DATE: 12/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/04/2023


LIC809 (FAS) - (06/04)
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