Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 540405030
Report Date: 08/05/2016
Date Signed 08/05/2016 04:38:28 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 E.SHAW AV,STE 300-MS 29-01
FRESNO, CA 93710
FACILITY NAME:GREENHOUSE MONTESSORI SCHOOLFACILITY NUMBER:
540405030
ADMINISTRATOR:HOFFMAN, ANNEFACILITY TYPE:
850
ADDRESS:4143 S. DANS LANETELEPHONE:
(559) 625-8385
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY:82CENSUS: 42DATE:
08/05/2016
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Nina ClancyTIME COMPLETED:
11:30 AM
NARRATIVE
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Licensing Program Analysts (LPA), Norma Lomeli conducted an unannounced case management visit to follow up on an Unusual Incident Report that occurred on 8/1/2016 and was reported on 8/2/16. LPA toured the facility, interviewed staff, reviewed files and sign in/out sheets. During the visit it was determined that a child wandered off from the facility. During the staff interviews it was revealed that preschool children eat lunch and have outside playtime on the preschool playground during the hours of 11:30AM -1:00PM. Staff revealed that Child #1 was eating lunch on a picnic table and since child is a slow eater child was the last one eating lunch. Staff revealed that child was last seen around 12:10PM and all staff that LPA interviewed stated that they did not see child wander off. Staff #3 revealed that as she was driving back from lunch into the facility's parking lot between 12:20PM-12:25PM, she observed a child standing next to a red bicycle structure outside of the facility without any supervision. LPA asked Staff #3 to show where she found Child #1, in which she directed LPA to the outside of the front of the facility. LPA observed a red bicycle that sits about 40-50 feet from the front entrance of the facility and South Dans Street is about 15-20 feet away from the red bicycle structure. Staff #3 stated that she ran to child and asked child, "What are you doing out here?" Staff #3 grabbed child from hand and took child into the facility, to the outside playground and left Child #1 under the supervision of Staff #2. Staff #3 stated that she immediately informed Director Anne Hoffman of incident. Director Nina stated that she was not at the facility the day the incident occurred, Anne Hoffman was the director in charge. Director Nina stated that when she came in to on 8/2/2016 and spoke to Father of Child #1, he informed her that he was informed of incident when he arrived to pick up child and not immediately how it was reported to the Officer of the Day. Director Nina stated that the Unusual Incident Report that was mailed to CCL has the correction.

Per Chapter 1, Division 12, Title 22 of California Code of Regulations the following deficiency was cited today. See (LIC809-D) on next page.
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(Continued on LIC809-C):
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)243-8103
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)243 -8416
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2016
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 E.SHAW AV,STE 300-MS 29-01
FRESNO, CA 93710
FACILITY NAME: GREENHOUSE MONTESSORI SCHOOL
FACILITY NUMBER: 540405030
VISIT DATE: 08/05/2016
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Exit interview was conducted with Director, Nina Clancy. Director, Nina Clancy was provided a copy of their appeal rights (LIC9058) and their signature on this form acknowledges receipt of this form. LPA observed the Notice of Site Visit report was posted and advised to post for 30 days where parents may easily view.

"Upon receipt of any A violation, licensee shall post and provide copies of this licensing report and LIC9224 to parents/guardians of children in care at the facility and to parents/guardians of children upon enrollment at the facility during the next 12 months, LIC9224 to be signed verifying receipt and filed in children's files."
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)243-8103
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)243 -8416
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2016
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
CCLD Regional Office, 770 E.SHAW AV,STE 300-MS 29-01
FRESNO, CA 93710
FACILITY NAME: GREENHOUSE MONTESSORI SCHOOL
FACILITY NUMBER: 540405030
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/06/2016
Section Cited
101229(a)(1)
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CARE AND SUPERVISION. No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time except as specified in sections 101216.2(e)(1) and 101230(c)(1). During the visit it was revealed that preschool children eat lunch and have outside playtime on the preschool playground during the hours of 11:30AM -1:00PM. Staff revealed that Child #1 was eating lunch on a picnic table and
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Licensee shall ensure that staff has visual observation of the children at all times.
Licensee will develop a log/check list of children's head count when inside the classroom and outside in the playground. The log/checklist shall include child's name, time, date and staff signatures. Staff to be provided with training on visual supervision and yard monitoring of the children in care.
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since child is a slow eater child was the last one eating lunch. Staff revealed that child was last seen around 12:00PM and all staff that LPA interviewed stated that they did not see child wander off. This is an immediate risk to the health and safety of children. It is a Zero Tolerance Violation and an immediate civil penalty of $150.00 and a $150.00 a day until corrected.
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Copies of log/check list and training outline to be received at the Fresno CCL office on or before 8/11/2016. Director states that she will conduct staff training on 9/2/2016 and will provide CCL a copy of staff sign in sheet on or before 9/3/2016.
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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: Duane MatsubaraTELEPHONE: (559)243-8103
LICENSING EVALUATOR NAME: Norma LomeliTELEPHONE: (559)243 -8416
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2016
LIC809 (FAS) - (06/04)
Page: 2 of 3