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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344500189
Report Date: 05/17/2024
Date Signed: 05/17/2024 12:01:06 PM

Document Has Been Signed on 05/17/2024 12:01 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/
DIRECTOR:		MENDOZA, CHRISTINEFACILITY TYPE:
850
ADDRESS:8930 SIERRA STREETTELEPHONE:
(916) 686-5800
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 83TOTAL ENROLLED CHILDREN: 83CENSUS: DATE:
05/17/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
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On 5/17/2024, Licensing Program Analyst (LPA) Jennie Tedlos, met with Director Christine Mendoza for the purpose to conduct an unannounced case management inspection due to deficiencies. LPA observed 48 children supervised by 10 staff.

Upon conducting record review for the complaint investigation that was initiated on 05/01/2024, LPA observed documentation detailing an incident that occurred on 02/02/2024. The document revealed that a child was left outside in the facility's play yard without staff supervision. This incident was not reported to the Community Care Licensing Department.

LPA Tedlos informed Director Mendoza that this report dated 05/17/2024, documents one Type B citation, regarding reporting requirements, stating there is a potential risk to the health, safety, or personal rights of children in care. This report also documents one Type A citation, regarding an absence of supervision, stating there is an immediate risk to the health, safety or personal rights of children in care. This Type A citation is a repeat violation for which a civil penalty is assessed on a subsequent page (LIC421FC).

Upon receipt of Type A citations, the licensee shall post and provide copies of the LIC 9099-D for parents/guardians of children in care and for parents/guardians of newly enrolled children for the next 12 months. Licensee must also keep the signed LIC 9224, acknowledging receipt of LIC 9099-D in each child's file.



An exit interview conducted, and report was reviewed with the Director, Christine Mendoza. Appeal of Rights were provided. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.00.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2024
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 05/17/2024 12:01 PM - It Cannot Be Edited


Created By: Jennie Tedlos On 05/17/2024 at 09:46 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: ART OF MONTESSORI
FACILITY NUMBER: 344500189

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/21/2024
Section Cited
CCR
101212(d)

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101212 Reporting Requirements (d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department ...within the Department's next working day... a written report containing the information shall be...
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Director shall submit an Unusual Incident Report to LPA about the incident that took place on 2/2/24. Director will watch the CCLD training video on Reporting Requirements and write and send a statement to LPA acknowleging their understanding on what incidents to report to CCLD.
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submitted... within 7 days...
This requirement was not met as evidenced by: LPA learned that a child was left in the play yard without staff supervision 2/2/24 & was not reported to CCLD. This poses an potential health & safety risk to 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:Karyn Guerra
LICENSING EVALUATOR NAME:Jennie Tedlos
LICENSING EVALUATOR SIGNATURE:
DATE: 05/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/17/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/17/2024 12:01 PM - It Cannot Be Edited


Created By: Jennie Tedlos On 05/17/2024 at 09:59 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: ART OF MONTESSORI
FACILITY NUMBER: 344500189

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/20/2024
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 states that a staff meeting was held after the incident took place. Director states that an assigned "sweeper" checks the play yard area for children when transitioning inside. Administration and staff will watch the CCLD training video regarding Supervising Children in Child Care Centers. Director will
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This requirement was not met as evidenced by: LPA learned through record review that a child was left in the play yard without staff supervision on 2/2/24. This poses an immediate risk to the health and safety of children in care.
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send LPA the signatures from all staff acknowleging that they completed watching the video. Civil Penalty of two hundred fifty dollars($250.00) will be assessed on the next page (LIC 421FC).

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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:Karyn Guerra
LICENSING EVALUATOR NAME:Jennie Tedlos
LICENSING EVALUATOR SIGNATURE:
DATE: 05/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/17/2024


LIC809 (FAS) - (06/04)
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