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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364830892
Report Date: 12/19/2022
Date Signed: 12/20/2022 10:13:38 AM

Document Has Been Signed on 12/20/2022 10:13 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:MONTESSORI ACADEMY OF CHINOFACILITY NUMBER:
364830892
ADMINISTRATOR:DE SILVA, MAVANANEFACILITY TYPE:
850
ADDRESS:4511 RIVERSIDE DRIVETELEPHONE:
(909) 591-3937
CITY:CHINOSTATE: CAZIP CODE:
91710
CAPACITY: 60TOTAL ENROLLED CHILDREN: 43CENSUS: 19DATE:
12/19/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Ariana GomezTIME COMPLETED:
04:10 PM
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On 12/16/2022 at 9:02 am, Licensing Program Analyst (LPA), Patricia Berry conducted a case management inspection due to required lead testing requirements based on lead testing results received on the facility. LPA toured Rooms B and D, took census and met with Ariana , director to further discuss lead results received and measures taken for remediation of lead exceedances.

During the inspection, LPA toured and observed the following water outlets identified with lead exceedances: outlet B (tested at 15) and D (tested at 6.1) were identified; Outlet B is a hand washing sink/ water fountain that is located in classroom B and outlet D is located in classroom D , which is not licensed by CCLD and is utilized by the private kindergarten. LPA verified that the required signage for cessation of use was in place.

Facility implemented the following plan of action until formal remediation can be completed on water outlet B . The Director covered water outlets, posted required signage for non-use and will complete repairs to the outlets affected. Facility is in the process of repairs and retesting. LPA observed notification of lead results posted on classroom B and D. Children bring their own water bottle from home and a jug of water is kept in each classroom. The jugs are filled as needed in the kitchen, not the classrooms

Due to facility water outlet testing for lead exceedance level above approved lead levels, a deficiency has been cited. See LIC809D.

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Rachel Zeron
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: MONTESSORI ACADEMY OF CHINO
FACILITY NUMBER: 364830892
VISIT DATE: 12/19/2022
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Additionally, the following resources were discussed and provided from PIN 21-21-CCP dated July 28, 2021:

101700.6 Grant Funding for Qualifying Child care Centers

(a) Senate Bill 862, Chapter 449, Statutes of 2018 allocated $5 Million to the State Water Resources Control Board for testing and remediation of lead in the drinking water of Child Care Centers based on the following criteria:

(1) Those that serve children zero to five years of age, with the highest priority for Child Care Centers that provide care for children zero to three years of age.

(2) Those that have 50 percent or more of their registered children who receive subsidized care.

(3) Those that operate only one facility.

(b) To determine a Child Care Center’s eligibility for possible funding the Department will provide access to a link to an online eligibility form located on the Department’s website and on Sacramento State’s Office of Water Programs website.

(1) A Child Care Center interested in financial assistance shall complete the eligibility form, which shall include instructions for completing and returning it, prior to receiving any grant funding for which it may qualify. To determine a Child Care Center’s eligibility for possible funding, the provider will need to complete an online eligibility form available at Office of Water Programs’ website

An exit interview was conducted, LPA provided Ariana Gomez, Director with a copy of this report, appeal rights and notice of site visit. This report must be made available to the public upon request for three years.

Notice of Site Visit must be posted for 30 days.

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Rachel Zeron
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/20/2022 10:13 AM - It Cannot Be Edited


Created By: Rachel Zeron On 12/19/2022 at 03:39 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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: MONTESSORI ACADEMY OF CHINO
FACILITY NUMBER: 364830892

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/19/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/09/2023
Section Cited
CCR
101700.3(b)(1)

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California Lead Action Level at Child Care Centers 101700.3 (b)(1): A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.
This requirement is not met as evidence by:
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Director agrees to remove the water fountain on outlet B and the sink will be used by staff and children for hand washing only. Director will submit photos when fountain is removed by POC date
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Based on records review of required lead testing, the facility had lead values of 5.5 ppb or above on water outlets: B (15) & D (6,1).

This is a potential health and safety risk to persons 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:Aaron Ross
LICENSING EVALUATOR NAME:Rachel Zeron
LICENSING EVALUATOR SIGNATURE:
DATE: 12/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/19/2022


LIC809 (FAS) - (06/04)
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