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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700725
Report Date: 06/02/2023
Date Signed: 06/02/2023 01:09:21 PM

Document Has Been Signed on 06/02/2023 01:09 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:CASA MONTESSORI DE CARLSBADFACILITY NUMBER:
376700725
ADMINISTRATOR:MARILY MIRANDAFACILITY TYPE:
850
ADDRESS:3470 MADISON STREETTELEPHONE:
(760) 729-4455
CITY:CARLSBADSTATE: CAZIP CODE:
92008
CAPACITY: 49TOTAL ENROLLED CHILDREN: 49CENSUS: 43DATE:
06/02/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Marily MirandaTIME COMPLETED:
01:25 PM
NARRATIVE
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On 06/02/23 at 12:15pm, Licensing Program Analyst (LPA) Samantha Clenista, conducted an unannounced case management inspection. Purpose of this visit is to issue facility a Type B citation for failing to notify the department regarding prior room changes. After a thorough file review was conducted, LPA observed that the toddler room was licensed where Primary I room is currently located. Facility had switched the toddler room at some point without notifying CCL.

Upon arrival, LPA met with Center Director, Marily Miranda. The following were present in each classroom: 11 toddlers with 2 staff in the Toddler Room, 15 children with 2 staff in Primary I Room, and 17 children with 2 staff in Primary II Room. Appropriate ratio, capacity and supervision was provided.

See 809D for cited deficiency. NOTICE OF SITE VISIT IS TO BE POSTED FOR 30 DAYS. LPA observed Director post notice of site visit.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Samantha Clenista
LICENSING EVALUATOR SIGNATURE: DATE: 06/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/02/2023
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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Document Has Been Signed on 06/02/2023 01:09 PM - It Cannot Be Edited


Created By: Samantha Clenista On 06/02/2023 at 12:46 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: CASA MONTESSORI DE CARLSBAD
FACILITY NUMBER: 376700725

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/09/2023
Section Cited
CCR
101212(c)

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The licensee shall notify the Department in writing of his/her intent prior to making any structural changes that reduce the total amount of indoor or outdoor activity space. Such structural changes shall include, but not be limited to, room additions.
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LPA printed the reporting requirements regulation and provided it to Director. Director reviewed the regulation during inspection and stated her understanding. Director provided a statement acknowledging her understanding of the regulation and will report any changes to CCL prior to any changes.
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This requirement was not met as evidenced by; after conducting a thorough file review, LPA observed that the toddler room was licensed where Primary I room is currently located. Facility had switched the toddler room at some point without notifying CCL. This poses a Potential Health and Safety risk to the clients in care.
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Deficiency is cleared during visit.

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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:Monica Cuddy
LICENSING EVALUATOR NAME:Samantha Clenista
LICENSING EVALUATOR SIGNATURE:
DATE: 06/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/02/2023


LIC809 (FAS) - (06/04)
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