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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444408893
Report Date: 08/07/2023
Date Signed: 08/07/2023 03:22:19 PM

Document Has Been Signed on 08/07/2023 03:22 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:QUAIL HOLLOW MONTESSORIFACILITY NUMBER:
444408893
ADMINISTRATOR:CYNTHIA LAURINFACILITY TYPE:
850
ADDRESS:187 LAUREL DRIVETELEPHONE:
(831) 335-4710
CITY:FELTONSTATE: CAZIP CODE:
95018
CAPACITY: 42TOTAL ENROLLED CHILDREN: 25CENSUS: 15DATE:
08/07/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:31 PM
MET WITH:Mindy Gillen & Cheryl McGowenTIME COMPLETED:
03:36 PM
NARRATIVE
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Licensing Program Analyst (LPA), Cortney Nelson, met with Facility Representative, Cheryl McGowen, to follow-up on incident that was self reported to the Department on 7/18/2023. Shortly after arriving to the facility, Owner, Mindy Gillen, arrived.

On 7/18/2023, the facility self-reported that a child was left outside during a transition from outside to inside for approximately 15 minutes. During that time, the child was left outside, however remained inside of the gated playground area until staff were alerted that the child was outside by nearby construction workers. Upon return to the classroom, staff report that the child was fine and offered a snack. Staff report that on the day of the incident, there were large construction vehicles located outside of the facility.

Cheryl states that moving forward, staff will now conduct roll call every morning, including transitions inside and outside. On the day of the incident, Cheryl was subbing in the infant room, and is typically able to supervise staff working with preschool-age children. Following the incident, Cheryl states that she has met with staff to discuss importance of visual supervision at all times. Cheryl additionally states that the facility will now be counting role from two staff members for all transitions to confirm all children are present.

LPA informed licensee, Mindy Gillen, that this report dated (8/7/2023) documents one Type A citation, which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA informed the licensee to provide a copy of this licensing report dated (8/7/2023) that documents any Type A citation 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.

As a result of today's inspection, a deficiency has been cited, see LIC809-D.

Exit interview conducted and report was reviewed with Facility Representative, Cheryl McGowen, and Owner, Mindy Gillen.

A NOTICE OF SITE VISIT HAS BEEN GIVEN AND MUST BE POSTED FOR 30 DAYS.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE: DATE: 08/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/07/2023
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 08/07/2023 03:22 PM - It Cannot Be Edited


Created By: Cortney Nelson On 08/07/2023 at 02:50 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: QUAIL HOLLOW MONTESSORI
FACILITY NUMBER: 444408893

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/08/2023
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time...Supervision shall include visual observation.

This requirement was not met as evidenced by:
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The Licensee has conducted staff meetings with staff to highlight priorities, including importance of constant visual observation. Written attestations from day of incident for staff present have been submitted.
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The Licensee did not ensure that children were visually supervised at all times, as on 7/18/2023 a child was left outside unattended, which is an immediate risk to the health, safety, and personal rights of children in care.
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The facility is now using a new process during transitions, including two staff members counting children in attendance, and confirming children on a daily roster.
-Civil penalty assessed-

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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:Joel Segura
LICENSING EVALUATOR NAME:Cortney Nelson
LICENSING EVALUATOR SIGNATURE:
DATE: 08/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/07/2023


LIC809 (FAS) - (06/04)
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