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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623400
Report Date: 02/26/2024
Date Signed: 02/26/2024 10:51:29 AM

Document Has Been Signed on 02/26/2024 10:51 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:GUIDEPOST MONTESSORI AT FOLSOMFACILITY NUMBER:
343623400
ADMINISTRATOR:KIANA KOMENTANIFACILITY TYPE:
850
ADDRESS:777 LEVY ROADTELEPHONE:
(916) 836-8899
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY: 156TOTAL ENROLLED CHILDREN: 156CENSUS: 29DATE:
02/26/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Kiana KomentaniTIME COMPLETED:
11:00 AM
NARRATIVE
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On 02/26/2024, an unannounced case management inspection was conducted by Licensing Program Analyst (LPA) Jennifer Velasco. LPA met with facility representative, Director Kiana Komentani (Director), who was advised of the purpose of this inspection. This inspection was conducted to follow up on a 02/12/2024 unusual incident that was self-reported to Community Care Licensing (CCL) as required. During this inspection, LPA toured the facility, conducted interviews, and reviewed relevant facility documentation.

LPA informed Director that this 02/26/2024 report documents one Type A citation and must be posted for 30 consecutive days as there was immediate risk to the health, safety, and/or personal rights of children in care. LPA informed Director to provide a copy of this licensing report that documents a Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other equivalent written statement, must be placed in the child's file for verification. Exit interview with Director Kiana Komentani was conducted, and appeal rights were provided. Notice of site visit was provided and must be posted for 30 consecutive days for parental review.

See continuation page LIC 9099-D for deficiency.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE: DATE: 02/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/26/2024
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 02/26/2024 10:51 AM - It Cannot Be Edited


Created By: Jennifer Velasco On 02/26/2024 at 09:17 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GUIDEPOST MONTESSORI AT FOLSOM
FACILITY NUMBER: 343623400

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/27/2024
Section Cited
CCR
101229(a)(1)

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(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time ... shall include visual observation.
This requirement was not met as evidenced by record review and witness
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Director stated all staff have been given direct instruction and training to ensure the door is closed with the clip removed, and that each child's presence in the group that has transitioned with the staff is verified.
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statements that, in a self-reported incident, two toddlers were left without supervision on the playground for five minutes. This is an immediate health, safety, and/or personal rights risk to children in care
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Director stated staff have received extra trining from school leadership to ensure transitions include extra monitoring of children. POC met.

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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:Natalie Dunaway
LICENSING EVALUATOR NAME:Jennifer Velasco
LICENSING EVALUATOR SIGNATURE:
DATE: 02/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/26/2024


LIC809 (FAS) - (06/04)
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