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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376105015
Report Date: 06/23/2022
Date Signed: 06/23/2022 02:43:23 PM

Document Has Been Signed on 06/23/2022 02:43 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:INTELLICHILDREN MONTESSORI INSTITUTEFACILITY NUMBER:
376105015
ADMINISTRATOR:BRANDY PEARCEFACILITY TYPE:
830
ADDRESS:212 WEST SAN MARCOS BOULEVARDTELEPHONE:
(760) 471-0221
CITY:SAN MARCOSSTATE: CAZIP CODE:
92069
CAPACITY: 20TOTAL ENROLLED CHILDREN: 10CENSUS: 9DATE:
06/23/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Brandy PearceTIME COMPLETED:
02:50 PM
NARRATIVE
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On June 23, 2022 at 1:45 p.m. Licensing Program Analyst, Leilani Curtis, conducted an unannounced inspection to follow up on a self-reported incident that occurred on 6/16/22, wherein the parents of a child enrolled at the associated preschool, facility #376105016 engaged in a domestic dispute in the facility parking lot. LPA met with Director Pearce and proceeded to tour the facility. There were 9 children with 3 staff members present. Appropriate ratio/capacity were observed. Staff members have the required background clearances and are associated to the facility.

LPA interviewed Director Pearce. On 6/16/22 at approximately 9:00 a.m., parent #2 (P2) of child #1 (C1) attacked and injured parent #1 (P1) of C1 in the facility parking lot. Facility staff administered first aid to the injured parent (P1). C1 was in the building at the time of the incident. The facility was placed on “lockdown” and the police and an ambulance were called. None of the staff or children were injured. Parents of all children enrolled were contacted to pick up their children. All children were removed from the facility by 1:00 p.m. The facility was closed for the remainder of the day and Friday, 6/17/22. The facility reopened on Monday, 6/20/22. At the time of the incident there were 4 children in the facility being supervised by 3 staff members. Appropriate ratio/supervision was in place. The staff members responded appropriately, and the parents was notified timely. Community Care Licensing was notified of the incident via fax on 6/21/22. The facility failed to notify the department within 24 hours of the incident or by the next business day. The director states that she completed the Unusual Incident Report, LIC624 on Monday, 6/20/22 but did not notify or submit the paperwork to department until 6/21/22 due to being busy with parents.

See LIC809D for cited deficiencies.

An exit interview was conducted with the director and appeal rights (LIC 9058 1/16) were discussed. The director’s signature on this form acknowledges receipt of these rights. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS. LPA observed the director post notice of site visit.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Grace Curtis
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2022
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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Document Has Been Signed on 06/23/2022 02:43 PM - It Cannot Be Edited


Created By: Grace Curtis On 06/23/2022 at 01:52 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
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: INTELLICHILDREN MONTESSORI INSTITUTE
FACILITY NUMBER: 376105015

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/23/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/30/2022
Section Cited
CCR
101212(d)(1)(C)

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101212(d)(1)(C) Reporting Requirements: (d) 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...(1)Events reported shall include the following: (C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child. This requirement was not met as evidenced by:
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The director states that she will watch the video on Child Care Reporting Requirements on the Community Care Licensing website (www.ccld.ca.gov) and submit to LPA a signed and dated summary of the requirements via email by 6/30/22.
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Based on the director's statement, the facility failed to notify the Department of the assault and facility "lockdown" that occurred on 6/16/22 within the Department's next business day. This poses a potential health and safety risk to the children 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:Tashima Daniel
LICENSING EVALUATOR NAME:Grace Curtis
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2022


LIC809 (FAS) - (06/04)
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