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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364841683
Report Date: 11/25/2025
Date Signed: 11/25/2025 04:29:34 PM

Document Has Been Signed on 11/25/2025 04:29 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:MONTESSORI SCHOOL OF CHINO HILLSFACILITY NUMBER:
364841683
ADMINISTRATOR/
DIRECTOR:		TONI ESPINOFACILITY TYPE:
850
ADDRESS:14635 PIPELINE AVENUETELEPHONE:
(909) 393-1982
CITY:CHINOSTATE: CAZIP CODE:
91710
CAPACITY: 124TOTAL ENROLLED CHILDREN: 111CENSUS: 41DATE:
11/25/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:09 AM
MET WITH:Keshini WijegoonaratnaTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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On 11/25/2025, Licensing Program Analyst (LPA) Samuel Lopez arrived to the facility to address a separate and unrelated issue. Prior to entering inside the facility, LPA Lopez observed a white van with red letters on the windows which identified the facility, the phone number, and the age of children that they provide care for however, the facility (license) numbers were not listed.

LPA Lopez entered the facility and requested to speak to the Director and/or licensee and was informed that they were not available. Minutes later, Keshini Wijegoonaratna arrived stating that they were covering, at this time, and would assist the LPA. LPA requested a tour of the facility and observed a pool with only a few feet of rain water, located at the rear end of the facility, connected to the playground. The pool was surrounded mostly by a chain link fence that was over five foot in height, and one side with cinder block, which was shared wall with the back property (vacant lot). Also observed was a self latching/closing door that opens away from the pool. However, the key lockable device on the door was placed lower than the 60 inches, as required.

In speaking with staff, it was shared that the facility had an incident occur on November 19, 2025, where a child tripped and fell on the playground, causing a gash on their hip, which bled. The incident was reported to the parent/legal guardian however, due to the nature of the injury, it should have been reported to the Riverside Child Care Regional Office, and was not.

See LIC809-D for cited deficiencies

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the covering Director Keshini Wijegoonaratna.

NAME OF LICENSING PROGRAM MANAGER: Aaron Ross
NAME OF LICENSING PROGRAM ANALYST: Samuel Lopez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/25/2025
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 4
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 11/25/2025 04:29 PM - It Cannot Be Edited


Created By: Samuel Lopez On 11/25/2025 at 01:00 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 SCHOOL OF CHINO HILLS
FACILITY NUMBER: 364841683

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/25/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/05/2025
Section Cited
HSC
1596.814(a)(1)(A)(i)

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Pool Safety: (i) An access gate that opens away from the swimming pool and is self-closing with a self-latching, key lockable device placed no lower than 60 inches above the ground.
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Licensee representative agrees to fix/repair the locking device to meet the requirements. Proof of repair to be submitted to the Riverside Child Care Regional Office by 12/5/2025.
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This requirement is not met as evidenced by oservation and measurement taken that the lockable device was less than 60 inches from the ground. This poses/posed a potential health and safety or risk to persons in care.
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Type B
12/05/2025
Section Cited
CCR101212(d)

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Reporting Requirements: 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 by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written
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Licensee representative agrees to submit an unusual incident report (LIC 624) related to the incident occurred and a written plan as to how the facility will maintain compliance with the cited section. These items are to be submitted to the Riverside Child Care Regional Office by 12/5/2025.
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report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. This requirement was not met based on interview that an incident occurred where a child was injured and it was not reported to the Department.
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This poses/posed a potential health and safety or risk to persons
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Aaron Ross
NAME OF LICENSING PROGRAM MANAGER:
Samuel Lopez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 11/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/25/2025


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 11/25/2025 04:29 PM - It Cannot Be Edited


Created By: Samuel Lopez On 11/25/2025 at 01:14 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 SCHOOL OF CHINO HILLS
FACILITY NUMBER: 364841683

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/25/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/05/2025
Section Cited
CCR
101162(a)(1)

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Advertisements and License Numbers: Licensees shall reveal each child care center license number in all advertisements in accordance with Health and Safety Code Section 1596.861.
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Licensee representative agrees to add the facility license numbers on the van and submit proof to the Riverside Child Care Regional Office by 12/5/2025.
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This requirement is not met as evidenced by observation of the facility van that has facility name, phone number, and ages of children they provide services for but, not the facility license number. This poses/posed a potential health and safety or risk to persons
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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.
Aaron Ross
NAME OF LICENSING PROGRAM MANAGER:
Samuel Lopez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 11/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/25/2025


LIC809 (FAS) - (06/04)
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