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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364845472
Report Date: 07/12/2023
Date Signed: 07/12/2023 02:49:58 PM

Document Has Been Signed on 07/12/2023 02:49 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:
364845472
ADMINISTRATOR:THEWES, ADAMFACILITY TYPE:
830
ADDRESS:934 N. MOUNTAIN AVE., SUITE ETELEPHONE:
(909) 621-1603
CITY:UPLANDSTATE: CAZIP CODE:
91786
CAPACITY: 16TOTAL ENROLLED CHILDREN: 16CENSUS: 9DATE:
07/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Adam ThewesTIME COMPLETED:
03:00 PM
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On date and time listed above a required 1-year inspection is being conducted as a compliance review. Licensing Program Analyst (LPA), Giselle Carbullido toured the infant center, inside and out. LPA was granted entry by Director, Adam Thewes. The following was observed and or discussed:

The inspection consisted of reviews of the following domains: Food Service; Reporting Requirements
Physical Plant; Care and Supervision; Children Records; Staff Records; Staffing Ratio and Capacity and
Personal Rights. The inspection found the facility to be in compliance in these domains, except as noted on the LIC809-D. A deficiency was cited this visit.

· The licensee is asked to update the following documents, if applicable, and submit to licensing within 30 days if changes have been made:
1. LIC 500 Personnel Report
2. LIC 610 Emergency & Disaster Plan
3. Parent Handbook/ Program Curriculum/Admission policies and procedures/ fee schedule (only if changes have been made)
4. LIC 309 Administrative Organization
5. LIC 308 Designation of Administrative Responsibility

The following items have been posted and are updated where necessary:
License; Emergency Disaster Plan (LIC610) and Earthquake Preparedness Checklist (LIC9148)
Parent’s Rights Poster (PUB393); Personal Rights (LIC613A); Child Car Seat Law; Menu
· The facility is operating within the terms of the license: Yes
· Facility is clean, safe and sanitary and in good repair.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2023
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: 364845472
VISIT DATE: 07/12/2023
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·Rooms and activity areas are physically separated from other components: Yes
· Rooms are equipped with age-appropriate furniture and equipment in good condition.
· Uncontaminated drinking water is provided in both the indoor and outdoor activity areas by public water supply.
· Napping equipment is sufficient for capacity and meets licensing requirements. See LIC809D
· Rooms are clean and free of hazards.
· Materials and surfaces accessible to children are toxic free.
· No weapons stored at the facility.
· There are no bodies of water present. All wading pools or similar product must be emptied immediately after use and stored in an upright position.
· Medications are stored where inaccessible to infants: Located in Director office- lock box.
· Center is equipped to isolate and care for any child who becomes ill during the day.
· Toxins are locked and Hazards are stored where inaccessible to infants.
· Toileting area was observed to be safe, sanitary and in operating condition.
· Outdoor play area is physically separated by appropriate fencing and free of hazards.
· Outdoor activity areas are supplied with age and size appropriate equipment in good condition.
· There is sufficient cushioning material under high climbing equipment, swings, slides and similar equipment: rubber matting under artificial turf. Equipment is low to the ground.
· Measures are taken to keep the facility free of flies, other insects and rodents.
· Food preparation area is clean and free of vermin Yes.
· Food is stored appropriately and protected from contamination.
· All storage containers for solid waste have tight-fitting covers that are kept on, and in good repair.
· Individual feeding and Infant needs and service plans were reviewed and are complete for each individual infant: Yes- all current
· Infants up to 12 months shall have a sleeping plan as required with documentation of date, name, time of 15-minute check and staff initials. Yes.
· Infant files were reviewed and are complete Yes
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023
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: 364845472
VISIT DATE: 07/12/2023
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·Sign in/Sign out record was reviewed and meets regulation requirements:
· A Staff member is present with current Pediatric CPR/First Aid which expires on 08/23
· Opening and closing staff member’s CPR/First Aid expires on 08/23
· Director completed Health and Safety Training on 11/04/2007
· Staff qualifications and files were reviewed and are complete: Yes
· Staff have received on the job training for housekeeping, sanitation and universal health precautions
· Documentation of fire & earthquake drills to be conducted every six months: Last drill on 05/22/23.
· The Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov,
· Licensee was informed of the Department has inspection authority per Health and Safety Codes.

MyChildCarePlan.org – Centers and Family Child Care Homes- Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

· AB605 – Child day care facilities, birth to school-age license; Effective January 1, 2021


· AB2960 – Child care and development services, online portal – Effective June 20, 2022 - This bill requires the State Superintendent of Public Instruction (SSPI), within the California Department of Education (CDE), to develop and post on CDE's website a comprehensive child care and development services online portal for families and providers by June 30, 2022.
· Please subscribe at www.childcareadvocatesprogram to receive Department updates. They will be sent directly to your e-mail account once you have set up an account.
Duty Officer is available to answer questions Mon. – Fri. at 1-844-LET-US-NO (1-844-538-8766).

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at:
http://www.ada.gov/childqanda.htm For CCCs: Incidental Medical Services (IMS) policy was discussed
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023
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: 364845472
VISIT DATE: 07/12/2023
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- AB 1207 – Mandated Child Abuse Reporting: Child Day Care Personnel Training, beginning January 1, 2018 – Requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years.

CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES: Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5- years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP).

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. PIN 22-05-CCP Page Four. LPA referred licensee [or facility representative] to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Facility representative was reminded that all adults 18 and over living or working in the facility including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.



LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/12/2023 02:49 PM - It Cannot Be Edited


Created By: Giselle Carbullido On 07/12/2023 at 02:04 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 UPLAND
FACILITY NUMBER: 364845472

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101439.1(b)(1)
Infant Care Center Sleeping Equipment
(b) A crib or portable -crib meeting United States Consumer Product Safety Commission safety standards shall be provided for each infant who is unable to climb out of a crib. (1) Mattresses shall be firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the mattress so it cannot be dislodged.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation during tour of facility the licensee did not comply with the section cited above in that mattresses have sheets too large which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/19/2023
Plan of Correction
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Facility will submit pictures that mattresses are covered with a tight fitted sheet that is appropriate to mattress size to the department by POC due date 07/19/23.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Gilbert Sena
LICENSING EVALUATOR NAME:Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2023


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: 364845472
VISIT DATE: 07/12/2023
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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility representative, Adam Thewes
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023
LIC809 (FAS) - (06/04)
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