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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376105015
Report Date: 07/21/2022
Date Signed: 08/03/2022 03:19:37 PM

Document Has Been Signed on 08/03/2022 03:19 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: 20CENSUS: 7DATE:
07/21/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:28 PM
MET WITH:Janet AndradeTIME COMPLETED:
02:55 PM
NARRATIVE
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Licensing Program Analyst (LPA), Tyra Block conducted a Case Management- Deficiency visit upon deficiencies observed while conducting a complaint inspection. An infant was observed seated in a bouncer/ rocker in the sleep area with a bottle propped by a blanket while staff assisted other children with napping. LPA reviewed children's files for the sleep plans and sleep log. Sleep logs were reviewed for the month of June 2022 and for this day, 7/21/22. The sleep plans were not available.

See LIC809-D for deficiencies cited during the inspection.

An exit interview was conducted with licensee, Janet Andrade. A Notice of Site Visit was conducted and must be posted for 30 days.



This is an amendment of LIC809 to remove incorrect citation type previously noted.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Tyra Block
LICENSING EVALUATOR SIGNATURE: DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2022
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 2
Document Has Been Signed on 07/21/2022 03:09 PM - It Cannot Be Edited


Created By: Tyra Block On 07/21/2022 at 01:33 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: 07/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/28/2022
Section Cited
CCR
101427(h)

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101427(h)- Infant Care Food Service: Infants who are unable to hold a bottle shall be held by a staff person or other adult for bottle feeding. At no time shall a bottle be propped for an infant...This requirement was not met as evidenced by:
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Licensee stated she will have a meeting with the infant staff to train on Infant Needs and Services including Care and Supervision. A meeting agenda with staff signatures will be provided by POC due date.
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LPA observed an infant seated in a rocker/ bouncer with a bottle propped by a blanket in the nap area as staff assisted other children with napping. This poses a potential health and safety risk to children in care
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Type B
07/28/2022
Section Cited
CCR101419.2(b)(2)

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101419.2(b)(2)- Infant Needs and Services Plan: Infants up to 12 months of age shall have a completed Individual Infant Sleeping Plan [LIC 9227 (3/20)], which is incorporated by reference. This requirement was not met as evidenced by:
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Licensee stated she will print LIC 9227 Sleep Plan forms tomorrow and will provide them to current parents to complete and she will have future parent complete the form upon enrollment. Licensee will provide signed copies for current infants to LPA by POC due date of 7/28/22.
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Sleep Plans were not on file with the Needs and Services Plan.
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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:Tyra Block
LICENSING EVALUATOR SIGNATURE:
DATE: 07/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2022


LIC809 (FAS) - (06/04)
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