364846333-8-31-2023-09-CC-SLOZ-CV8PGD-20230831111812

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364846333
Report Date: 08/31/2023
Date Signed: 08/31/2023 11:18:21 AM

Document Has Been Signed on 08/31/2023 11:18 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	MONTESSORI SCHOOL OF CHINO HILLS		FACILITY NUMBER:	364846333
ADMINISTRATOR:	SERASINGHE, RANJANIE		FACILITY TYPE:	840
ADDRESS:	14676 PIPELINE AVENUE (A - E)		TELEPHONE:	(909) 632-3545
CITY:	CHINO HILLS	STATE: CA	ZIP CODE:	91709
CAPACITY: 50	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	08/31/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:18 AM
MET WITH:	Director Ranjanie Serasinghe and Licensee Malraj Manikku		TIME COMPLETED:	11:30 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA), Samuel Lopez toured proposed the School Age center, inside and out. A Fire Clearance was granted on 8/16/2023. The days and hours of operation will be: Monday through Friday, 6:30am to 6:00pm. Measurements were taken and the following was determined: School-Age Indoor Activity Areas LPA has determined that there is sufficient space to accommodate 44 children - Will use Suites D and E only School-age Bathroom Fixtures 4 toilets x 15 = 60 children 4 sinks x 15 = 60 children School-Age Outdoor Activity Area: LPA has determined that there is sufficient space to accommodate 103 children. (playground is used by Private and Preschool programs. A waiver will be required in order to allow School Age children to share by way of alternating schedules) Limiting factor for school-age* capacity is square footage. School-age capacity is limited to 44 children. The following was observed: · Classrooms are adequately equipped with age and size appropriate furniture and equipment · Bottled water will supply drinking water in the indoor activity space · Playground is enclosed by an appropriate fence

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

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 SCHOOL OF CHINO HILLS	FACILITY NUMBER: 364846333
	VISIT DATE: 08/31/2023

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· Outdoor activity area is 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 (rubber tiles) is in place under play equipment
· Adequate shade is provided by shade structure
· Drinking water is provided in the outdoor play area by personal cups filled with bottled water
· Food preparation area is equipped with refrigerator, sink with hot and cold running water, storage area, utensils.
· The office area is located in Suite D and will serve as the isolation area for ill children temporarily until parents arrive
· Medication will be stored in the kitchen, in a cabinet, that is inaccessible to children
· Storage area for toxins and poisons is locked.
· Medication administration forms were reviewed
· First Aid kit is not available
· Sign in/Sign out record was reviewed and meets regulation requirements
· Component II Orientation was completed during this inspection
· The applicant 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 8/31/2023 indicates that the applicant is the only one associated with a Criminal Record Clearance

Director Ranjanie Serasinghe was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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 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.

The applicant can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations862@dss.ca.gov

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

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 SCHOOL OF CHINO HILLS	FACILITY NUMBER: 364846333
	VISIT DATE: 08/31/2023

NARRATIVE

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LPA discussed AB 2370 and provided a copy of PIN 21-21.1-CCP which explains the requirement for lead testing of water. All licensed Child Care Centers operating in buildings constructed before January 1, 2010, shall test their water for lead. Applicant has 180 from licensure to submit the required testing.
For more information visit:
https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. 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

LPA also informed Director Ranjanie Serasinghe 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.

LPA reviewed with Director Ranjanie Serasinghe the LIC 311A, Records to Be Maintained at The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

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

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

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 SCHOOL OF CHINO HILLS	FACILITY NUMBER: 364846333
	VISIT DATE: 08/31/2023

NARRATIVE

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The following items need to be completed/corrected prior to a license being issued:

1. Purchase and install carbon monoxide detector
2. Purchase food for snacks
3. Clear items from restroom in Suite E
4. Associate/Hire qualified staff
5. Update facility documents (LIC 500/LIC 610)
6. Submit waiver with schedule for playground sharing
7. Purchase First Aid kit with all required items per Title 22

Once all corrections have been made, with proof sent to licensing, the application will be submitted for approval with a maximum capacity of 44. As agreed, upon by the applicant, all corrections are due within 30 days. If not received within 30 days from the date of this report, the application will be denied.

Exit interview conducted and report was reviewed with the Director Ranjanie Serasinghe and Licensee Malraj Manikku.

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

LIC809 (FAS) - (06/04)

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