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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343616551
Report Date: 08/04/2022
Date Signed: 08/04/2022 05:38:36 PM

Document Has Been Signed on 08/04/2022 05:38 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:COUNTRYHILL MONTESSORIFACILITY NUMBER:
343616551
ADMINISTRATOR:WALKER, REONNAFACILITY TYPE:
850
ADDRESS:7048 SUNRISE BLVD.TELEPHONE:
(916) 728-2929
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 102TOTAL ENROLLED CHILDREN: 102CENSUS: 41DATE:
08/04/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Hamid HosseiniTIME COMPLETED:
05:50 PM
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At 11:45 a.m. on Thursday, August 4th, 2022, Licensing Program Analyst (LPA) Karyn Guerra met with Licensee, Hamid Hosseini, or the purpose of a Case Management - Deficiencies inspection.

During today's inspection, a file review was conducted. LPA did not observe signed acknowledgement of receipt of licensing reports LIC9224 forms in children's files for recent Type A deficiencies issued. LPA observed forms in some of children's files for Type A citations issues in January and February, but did not see any for any later Type A citations issued. Licensee, Hamid Hosseini, stated that there has been a recent transition with Directors and the forms have not yet been signed. This poses a potential risk to the health and safety of children in care.

at 12:44 p.m., LPA attempted to enter the Sprouts classroom where children were napping and was only able to partially open the door. A staff in the napping classroom informed LPA that there was a child sleeping in front of the doorway. Technical assistance was conducted.

At 2:40 p.m., LPA observed Staff 1 (S1) alone in the classroom with 5 children. At 2:41 p.m., Staff 2 (S2) came in from outside to relieve S1. S1 left the classroom and S2 was alone supervising 5 children. At 2:42 p.m., Staff 3 (S3) came in to assist S2. Through interviews and file reviews, it was learned that S1, S2, and S3 do not have ECE units. This poses an immediate risk to the health and safety of children in care. This is a repeat violation. Civil penalties were assessed.

report continued on 809-C.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Karyn Guerra
LICENSING EVALUATOR SIGNATURE: DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/04/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 08/04/2022 05:38 PM - It Cannot Be Edited


Created By: Karyn Guerra On 08/04/2022 at 01:51 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
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: COUNTRYHILL MONTESSORI
FACILITY NUMBER: 343616551

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/11/2022
Section Cited
CCR
101226(b)

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1012161 Teacher Qualifications and Duties. (b) Prior to employment a teacher shall meet the specified requirements...This requirement was not met, as evidenced by:
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Director will submit an updated staff schedule to LPA by POC to ensure that teachers are scheduled to supervise classrooms. LPA will conduct a follow up inspection to clear the citation.
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Based on observations, interview, and record review, S1, S2, and S3 were left alone with children and are not qualified teachers. This poses an immediate risk to the health and safety of children 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:Seychelle De Luca
LICENSING EVALUATOR NAME:Karyn Guerra
LICENSING EVALUATOR SIGNATURE:
DATE: 08/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/04/2022


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Document Has Been Signed on 08/04/2022 05:38 PM - It Cannot Be Edited


Created By: Karyn Guerra On 08/04/2022 at 02:27 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
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: COUNTRYHILL MONTESSORI
FACILITY NUMBER: 343616551

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/11/2022
Section Cited
HSC
1596.8595(c)

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(c)(1) A licensed child day care facility shall provide to the parents or guardians of each child receiving services in the facility copies of any licensing report that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care as set forth in paragraph (1) of subdivision (a) of Section 1596.893b...This requirement was not met, as evidenced by:
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Director and Licensee will ensure that parents receive licensing reports for Type A deficiencies and sign acknowledgement of receipt of licensing reports. Signed forms will be placed in children's files. LPA will conduct a file review during a follow up inspection.
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Based on interview and file review, the facility did not obtain signed acknowledgement of receipt of licensing reports LIC9224 from parents regarding recent Type A citations issued.
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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:Seychelle De Luca
LICENSING EVALUATOR NAME:Karyn Guerra
LICENSING EVALUATOR SIGNATURE:
DATE: 08/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/04/2022


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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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: COUNTRYHILL MONTESSORI
FACILITY NUMBER: 343616551
VISIT DATE: 08/04/2022
NARRATIVE
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Title 22 deficiencies are cited on the subsequent pages of this report. Licensee acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 9099D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee. LIC 9224 and Appeal Rights were provided. Licensee's signature on this report acknowledges receipt of these rights. This report was reviewed with the Licensee, Hamid Hosseini. An exit interview was conducted. A Notice of Site Visit was provided and shall remain posted for a period of 30 days.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Karyn Guerra
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022
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