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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344500189
Report Date: 08/29/2023
Date Signed: 08/29/2023 04:05:39 PM

Document Has Been Signed on 08/29/2023 04:05 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ART OF MONTESSORIFACILITY NUMBER:
344500189
ADMINISTRATOR:MENDOZA, CHRISTINEFACILITY TYPE:
850
ADDRESS:8930 SIERRA STREETTELEPHONE:
(916) 686-5800
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 83TOTAL ENROLLED CHILDREN: 83CENSUS: 39DATE:
08/29/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Christine MendozaTIME COMPLETED:
04:20 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Jennie Tedlos and Corina Beckby met with Director, Christine Mendoza to follow up on a self reported Unusual Incident Report (UIR) submitted by Christine Mendoza to Community Care Licensing on 08/23/2023. LPAs arrived at the facility and disclosed the purpose of the inspection and were granted entrance. During today's visit the facility was toured. Present were 39 children in care and 12 staff.

LPAs interviewed Director Christine as well as 3 staff who were present the day of the incident and obtained necessary documents. LPAs reviewed and discussed this report with the Director.

A Type A violation was assessed on a subsequent 809-D page.

An exit interview was conducted, and the report was reviewed with the Director. Licensee Appeal Rights were provided to facility. A Notice of Site visit was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 08/29/2023 04:05 PM - It Cannot Be Edited


Created By: Jennie Tedlos On 08/29/2023 at 03:16 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ART OF MONTESSORI
FACILITY NUMBER: 344500189

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/29/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/30/2023
Section Cited
HSC
1596.99(c)(3)(c)

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1596.99(c)(3) (c) The department shall assess an immediate civil penalty of five hundred dollars ($500) per violation and one hundred dollars ($100) for each day the violation continues ... (3) Absence of supervision, including, but not limited to, a child left unattended...
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Director fixed the fencing area that C1 escaped through the same day the incident occured. Director met with all teachers about the incident and about increasing frequent headcounts and supervision. Director scheduled a staff meeting on 9/5/23 which will
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This requirement was not met as evidenced by: Licensing was notified of an incident from facility staff and by unusual incident report that on 8/23/23, C1 was found alone in the facility parking lot for approximately 3 minutes. This poses an immediate risk to the health and safety of children in care.
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consist of supervision practices. Director will send LPA signatures of all staff members who will be attending the staff meeting.
Civil Penalty of five hunded dollars($500.00) will be assess on the next page (LIC 421M).

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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:Bettina Engelman
LICENSING EVALUATOR NAME:Jennie Tedlos
LICENSING EVALUATOR SIGNATURE:
DATE: 08/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/29/2023


LIC809 (FAS) - (06/04)
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