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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364845471
Report Date: 04/20/2023
Date Signed: 04/20/2023 12:17:35 PM

Document Has Been Signed on 04/20/2023 12:17 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:MONTESSORI ACADEMY OF UPLANDFACILITY NUMBER:
364845471
ADMINISTRATOR:THEWES, ADAMFACILITY TYPE:
850
ADDRESS:934 N. MOUNTAIN AVE., UNIT ETELEPHONE:
(909) 931-0511
CITY:UPLANDSTATE: CAZIP CODE:
91786
CAPACITY: 99TOTAL ENROLLED CHILDREN: 99CENSUS: 83DATE:
04/20/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Director/Licensee Adam ThewesTIME COMPLETED:
12:40 PM
NARRATIVE
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Licensing Program Analyst (LPA), Samuel Lopez arrived at the facility to conduct a Case Management inspection due to the request submitted for an increase in capacity. The facility is requesting to increase the Preschool Program capacity from 99 to 129. A Fire Clearance was granted on 4/11/2023.

The days and hours of operation will remain the same: Monday through Friday; 6:30am to 6:30pm.

LPA Lopez toured the facility and measured the rooms that are assigned to the Preschool Program. Based on the measurements taken, the following was determined:

Preschool Indoor Activity Areas
LPA has determined that there is sufficient space to accommodate 142 children.

Preschool Bathroom Fixtures
10 toilets x 15 = 150 children
15 sinks x 15 = 225 children

Preschool Outdoor Activity Area:
LPA has determined that there is sufficient space to accommodate 147 children.
*There is a waiver on file due to the School Age and Private School programs sharing the outdoor activity space*

Limiting factor for preschool capacity is the Fire Clearance granted.
Preschool capacity is limited to 129 children.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/20/2023
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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: MONTESSORI ACADEMY OF UPLAND
FACILITY NUMBER: 364845471
VISIT DATE: 04/20/2023
NARRATIVE
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The following was observed:
· Classrooms are adequately equipped with age and size appropriate furniture and equipment
· Filtered water supply drinking water in the indoor activity space
· Playgrounds are enclosed by appropriate fences
· Outdoor activity areas are supplied with age and size appropriate equipment
· There are no accessible bodies of water present. All wading pools or similar product must be emptied immediately after use and stored in an upright position.
· An adequate amount of cushioning material (wood chips) is in place under play equipment
· Adequate shade is provided
· Drinking water is provided in the outdoor play areas by personal cups filled with filtered water
· Toxins are locked
· The Director/Facility Representative/Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov
· A review of staff records on 4/20/2023 indicates that all facility staff or other individuals who require caregiver background checks had NOT received criminal record and child abuse index clearances or transfers/exemptions.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at:
https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at:
1-844-LET-US-NO (1-844-538-8766) and/or 951-782-4200

A Civil Penalty has been assessed during this inspection. Payment is due when billed and the check(s) or money orders shall be made payable to the “California Department of Social Services”. YOU WILL RECEIVE AN INVOICE IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE. DO NOT SEND CASH.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023
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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: MONTESSORI ACADEMY OF UPLAND
FACILITY NUMBER: 364845471
VISIT DATE: 04/20/2023
NARRATIVE
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See LIC809-D for cited deficiency.

LPA Samuel Lopez informed Licensee/Director Adam Thewes that this report dated April 20, 2023 document(s) (1) Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

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.



Also, LPA Samuel Lopez informed the Licensee/Director Adam Thewes to provide a copy of this licensing report dated April 20, 2023 that documents any Type A citation(s) 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 written statement, must be placed in the child's file for verification.

The following item(s) need to be completed/corrected prior to approval of the increase in capacity:

1. Plan of correction for cited deficiency

Exit interview conducted and report was reviewed with the Director/Licensee Adam Thewes.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/20/2023 12:17 PM - It Cannot Be Edited


Created By: Samuel Lopez On 04/20/2023 at 11:37 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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: MONTESSORI ACADEMY OF UPLAND
FACILITY NUMBER: 364845471

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/21/2023
Section Cited
CCR
101170(e)(2)

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Criminal Record Clearance: All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:
Request a transfer of a criminal record clearance as specified in Section 101170(f)
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Licensee associated the staff in question during the inspection. Licensee agrees to submit a written plan as to how verification of associations will be conductedto assure compliance with the cited deficiency. Plan to be submitted to the Riverside Child Care Regional Office by 4/21/2023
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Based on record review the licensee did not comply with the section cited above. Staff was providing care and supervision to children without being associated to the facilities license(s). This poses/posed an immediate health, safety or personal rights risk to persons in care.
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This citation has a $500.00 civil penalty.

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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:Samuel Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 04/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/20/2023


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