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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376105016
Report Date: 08/03/2022
Date Signed: 08/03/2022 03:16:36 PM

Document Has Been Signed on 08/03/2022 03:16 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:
376105016
ADMINISTRATOR:BRANDY PEARCEFACILITY TYPE:
850
ADDRESS:212 WEST SAN MARCOS BOULEVARDTELEPHONE:
(760) 471-0221
CITY:SAN MARCOSSTATE: CAZIP CODE:
92069
CAPACITY: 90TOTAL ENROLLED CHILDREN: 90CENSUS: 46DATE:
08/03/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Janet AndradeTIME COMPLETED:
11:00 AM
NARRATIVE
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On 8/3/22, Licensing Program Analyst (LPA), Tyra Block and Leilani Curtis, conducted an unannounced Case Management visit to provide amended report to reflect previous citations cited as Type B have been revised after review by management to reflect both deficiencies are a Type A due to the immediate risk to the health and safety of children in care. Present at the facility were 8 staff and 46 children.

Amended reports were signed and a copy provided. A Type A was also issued due to the absence of appropriate cushioning under the dome climber on the playground.

LPAs informed the licensee to provide a copy of the licensing reports dated 7/21/22 and 8/3/22 that document Type A citations 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. LIC 9224 was provided along with Parent Notification Requirements.

An exit interview was conducted, with Janet Andrade.

A Notice of Site Visit was provided and must be posted for 30 days.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Tyra Block
LICENSING EVALUATOR SIGNATURE: DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/03/2022
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 08/03/2022 03:16 PM - It Cannot Be Edited


Created By: Tyra Block On 08/03/2022 at 01:34 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: 376105016

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/03/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/04/2022
Section Cited
CCR
101238.2(e)

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101238.2(e) Outdoor Activity- As a condition of licensure, the areas around and under high climbing equipment, swings, slides and other similar equipment shall be cushioned with material that absorbs falls.
This requirement was not met as evidenced by:
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Licensee states she will look on amazon to see if she can find appropriate cushioning to place underneath or possibly remove the dome climber. She will submit receipt for cushioning or inform LPA of decision to remove climber and submit a photo of climber/ removal from playground by POC due date of 8/4/22.
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Based on observation and interview, the dome climber does not have appropriate cushioning underneath. Nap mats are being used as cushion. This poses an immediate health and safety risk to 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:Tyra Block
LICENSING EVALUATOR SIGNATURE:
DATE: 08/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/03/2022


LIC809 (FAS) - (06/04)
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