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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406208351
Report Date: 04/25/2025
Date Signed: 04/25/2025 01:39:50 PM

Document Has Been Signed on 04/25/2025 01:39 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:CHILDREN'S ACADEMY MONTESSORI SCHOOL, THEFACILITY NUMBER:
406208351
ADMINISTRATOR/
DIRECTOR:		TAMERA DAVISFACILITY TYPE:
850
ADDRESS:711 ROLLING HILLS DRIVETELEPHONE:
(805) 239-9790
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 23DATE:
04/25/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Tamera DavisTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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On 4/25/25, at 9:45 AM, Licensing Program Analyst (LPA) Matthew Sapien conducted an unannounced annual random Inspection of the abovementioned Child Care Center (CCC). LPA met with Tamera Davis, Director of the CCC, and explained the nature and purpose of the inspection. The LPA, in the company of the Director, toured the interior and exterior of the CCC. The CCC utilizes one primary school classroom, one toddler classroom, two restrooms (one restroom in each classroom), and two outdoor play areas for each classroom each of which are separated by a chain linked fence. The remainder of the building, like staff offices, staff bathrooms, and kitchen, are excluded from childcare services.

The CCC's hours of operation are 7:00 AM until 5:30 PM Monday through Friday. During the inspection, LPA observed 18 children in care in the primary school classroom along with 3 additional staff members who are cleared and associated. In the toddler classroom, LPA observed 5 children in care along with 2 additional staff members who are cleared and associated. LPA observed a total of 23 children in care along with 5 staff assistants.

The classrooms of the CCC are clean and orderly. The classrooms have age-appropriate books, equipment, and other furnishings for children in care. The classrooms contain a number of closets, cabinets, and other storage containers for childcare equipment, files, and other related items. In the toddler classroom, LPA observed multiple cleaning solutions in a cabinet beneath the teacher's sink that was in-reach of day care children. The bathroom within the primary classroom possesses 2 sinks and 2 toilets, and was clean and orderly. In said bathroom, LPA observed a large bottle of foaming hand soap stored on top of a cabinet that was in-reach of day care children. In the toddler classroom, LPA observed one toilet with one sink. This bathroom was clean and orderly. (CONT. LIC 809-C, Page 2).
NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Matthew Sapien
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/25/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CHILDREN'S ACADEMY MONTESSORI SCHOOL, THE
FACILITY NUMBER: 406208351
VISIT DATE: 04/25/2025
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As mentioned prior, the CCC houses a number of staff only areas like bathrooms, an office, and a kitchen area that possesses an operational refrigerator which contains food items for children in care along with staff items. The CCC provides one morning and one afternoon snack for children in care. Children bring lunches from home as well as reusable water bottles to drink with. There is available drinking water for children at the CCC via a 5-gallon water dispenser. The CCC also supplies children with reusable metal cups to drink with.

CCCs constructed before 1/1/20, are supposed to test their water (used for drinking and food preparation) for lead contamination before 1/1/23, and then every 5-years except after the date of the first test. For child care center licenses issued after 7/1/22, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). Through interview and record review, LPA verified that a lead testing waiver was issued for the CCC in July of 2023.

LPA observed required notices and other relevant documents posted prominently within the primary classroom of the CCC. LPA also reviewed the children's sign in and sign out forms in each of the classrooms and found the arrival times of children, along with spaces for departure times. The signatures of authorized representatives were also present.

LPA observed a carbon monoxide detector in the classrooms. A detector was tested at 11:34 AM and was found to be operational. In the primary school classroom, cleaning compounds and sharps are stored in elevated kitchen cabinets. Medication is stored on top of the refrigerator out of reach of children in care. In the toddler classroom, medication was stored on top of an elevated cabinet. Sharps were observed in an elevated cabinet and some cleaning solutions were stored on an elevated cabinet, while others were stored beneath the sink in an unlocked cabinet. LPA also observed a First Aid kit in the CCC that contains hydrogen peroxide, band aids, and other appropriate supplies.



The outdoor playground areas are enclosed by secure wooden and chain linked fencing throughout. A wooden gate and a chain linked gate is also present within the outdoor area. The fence’s entry and exit gates are secure and furnishings in the area are age appropriate. The play structures in the outdoor play areas have adequate cushioning material (rubber mulch) to absorb falls. The footing of the exterior has mixed footing (concrete pavement, artificial turf, and rubber mulch). Shade is provided by sun sails, trees, and by a wooden pergola. Director also attested that children are always supervised while outside and that the outdoor area is inspected prior to letting children outside.
(CONT. 809-C, Page 3)
NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Matthew Sapien
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2025
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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CHILDREN'S ACADEMY MONTESSORI SCHOOL, THE
FACILITY NUMBER: 406208351
VISIT DATE: 04/25/2025
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A sampling of staff and children's records were reviewed. The children’s records were complete and were found to contain emergency contact information as well admission agreements, among other relevant licensing documents and forms. Staff records were reviewed and contained current pediatric CPR and First Aid certifications (EMSA approved) and Mandated Reporter Training certificates among other relevant licensing documents. The last disaster drill on site occurred on 4/25/25. LPA reminded Director that disaster drills are required every six months by the Department. LPA confirmed that there are no bodies of water, firearms, or ammunition that are stored on site.

This facility does currently provide Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 and link to publication Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Facility representative was reminded that all adults 18 and over, including employees and volunteers,
as specified in HSC section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.



To improve the quality and value of the new inspection process, a survey may be sent to the email address
provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

During today's visit, one Type A Deficiency was issued (see LIC 809-D page) (CONT. 809-C, Page 4).
NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Matthew Sapien
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/25/2025 01:39 PM - It Cannot Be Edited


Created By: Matthew Sapien On 04/25/2025 at 12:44 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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: CHILDREN'S ACADEMY MONTESSORI SCHOOL, THE
FACILITY NUMBER: 406208351

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/25/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101238(g)
Buildings and Grounds
(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the Director did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/02/2025
Plan of Correction
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While the items were immediately moved to different areas upon observation, Director must still provide a written plan of correction as to how cleaning supplies will be stored in locked or elevated areas moving forward and why this is important. This must be submitted by close of business day (5:00 PM) on 5/2/25 to the Department (matthew.sapien@dss.ca.gov).
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Maria Mueller
NAME OF LICENSING PROGRAM MANAGER:
Matthew Sapien
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/25/2025


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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CHILDREN'S ACADEMY MONTESSORI SCHOOL, THE
FACILITY NUMBER: 406208351
VISIT DATE: 04/25/2025
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Upon receipt, Director shall provide copies of this licensing report to parents/guardians of children in care and to parents/guardians of children newly enrolled at the facility during the next 12 months. The Acknowledgement of Receipt (LIC 9224) to parents shall be completed and signed by each parent/guardian with copies maintained in each child's file. Licensee was given a copy of LIC 9224 Acknowledgement of Receipt of Licensing Reports.

An exit interview was conducted with Facility Representative, Tamera Davis. Facility Representative was provided with Appeal Rights (LIC 9058) and a Notice of Site Visit (LIC 9213). Notice of Site Visit must be posted for 30 days or a civil penalty of $100 may apply.

NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Matthew Sapien
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2025
LIC809 (FAS) - (06/04)
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