300600679-3-18-2024-06-CC-ASIA-D3GTY5-20240318150809

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300600679
Report Date: 03/18/2024
Date Signed: 03/18/2024 03:08:37 PM

Document Has Been Signed on 03/18/2024 03:08 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	MONTESSORI HOUSE OF CHILDREN		FACILITY NUMBER:	300600679
ADMINISTRATOR:	GUNAWARDENA, MAUREEN		FACILITY TYPE:	850
ADDRESS:	1239 SOUTH MAGNOLIA		TELEPHONE:	(714) 761-3109
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92804
CAPACITY:	26	CENSUS: 3	DATE:	03/18/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Director Maureen Gunawardena		TIME COMPLETED:	03:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 3/18/2024, Licensing Program Analyst (LPA) A. Silva conducted an unannounced an Annual/Random inspection assisted by Director Mauree Gunawardena and Licensee Shirani Perera. Upon arrival, total census was 3 preschool children. The facility was operating within ratios. Facility hours will be 9:00AM to 2:15PM, Monday through Friday. An on-site Facility Personnel Report Summary review showed that all facility staff or other individuals who require background checks have received criminal record and child abuse index clearances or exemption. The LPA inspected the indoor areas and areas accessible to clients at the time of the visit. The facility was equipped with smoke detector and working telephone service, and at least one fire extinguisher that meets statutory and State Fire Marshall standards. The carbon monoxide detector didn’t have batteries (See 809D). The director stated the last disaster drill was conducted on 12/01/23. The director stated that there are no firearms and/or other dangerous weapons in the facility; none were observed during the inspection. Detergents, cleaning compounds, medicines, and other items that could pose a danger if readily available were inaccessible to clients in care, except for one cylinder of a green cleaning compound labeled “comet” (See 809D), which was removed during the inspection. No poisons or other items that could pose a danger to clients were observed during the inspection. The facility provides age-appropriate toys, play equipment, and materials for the clients served. The classroom was littered with animal grey fur that looked like grey cat hair. The floor and walls were dirty; dirt accumulated on walls, at the base of the windows, (See 809D). The was a dry liquid substance that left dripping marks on the walls. There was a pungent ammonia-like smell in the classroom characteristic of cat or dog urine. A black cat and a chihuahua dog were observed roaming around the classroom. The licensee stated they also allow a grey cat inside the classroom. A type A citation was issued. The facility doesn’t meet all posting requirements. The child passenger restrain system and health department phone number were not posted at the time of inspection (See 809D).

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo Silva	TELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MONTESSORI HOUSE OF CHILDREN	FACILITY NUMBER: 300600679
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

101238(a)

Buildings and Grounds

(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interviews, the licensee did not comply with the section cited above in one of one classrooms, which poses an immediate health, safety or personal rights risk to persons in care. There is a pungent amonia-like smell in the classroom. The LPA identified it as dog/cat urine. A black cat and a chihuahua were observed roaming in the classrooms. A grey cat is also allowed in the classroom per licensee. LPA observed pet beds nad a cage in the classroom.
	POC Due Date: 03/19/2024
	Plan of Correction
1 2 3 4	The licensee stated they will wash the pet's bedding to see if that removes the smell from the facility. Licensee stated they will not allowed the cat in the classroom and will not keep a litter box in the classroom anymore.

Type A

Section Cited

CCR

101223(a)(2)

Personal Rights

(a) The licensee shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interviews, the licensee did not comply with the section cited above in one of one outdoor activity areas, which poses an immediate health, safety or personal rights risk to persons in care. The children were observed playing around animal (cat like) feces in the outdoor area. The licensee stated they usually have it cleaned but not today. There were feces in the swings and monkey bar areas. One child was seating on the floor were feces were observed.
	POC Due Date: 03/19/2024
	Plan of Correction
1 2 3 4	The licensee stated the feces will be removed from the outdoor activity area before the children go out to play.

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: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo Silva	TELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024

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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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MONTESSORI HOUSE OF CHILDREN	FACILITY NUMBER: 300600679
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.954

Licensure Requirements

Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interviews, the licensee did not comply with the section cited above in one of one carbon monoxide detectors, which poses/posed a potential health, safety or personal rights risk to persons in care. The LPA observed the CO2 detector didn't have bateries. S2 said they didn't have batteries for the detector.
	POC Due Date: 04/18/2024
	Plan of Correction
1 2 3 4	The licensee stated she will obtain an operable detector and install it by the due date.

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above in one of one drinking fountain in the classroom, which poses/posed a potential health, safety or personal rights risk to persons in care. S2 said the technician never went to test the water for lead.
	POC Due Date: 04/18/2024
	Plan of Correction
1 2 3 4	The licensee stated she will contact the lab who was supposed to test the water for lead and request a lead test. The licensee will provide proof of completion to the LPA

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: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo Silva	TELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024

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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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MONTESSORI HOUSE OF CHILDREN	FACILITY NUMBER: 300600679
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101169(d)(18)

Application for License

(18) Evidence that the applicant has posted signs at the entrance to the child care center that provide the telephone number of the local health department and information on child passenger restraint systems pursuant to Health and Safety Code section 1596.95(g) and Vehicle Code sections 27360 and 27360.5. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interviews, the licensee did not comply with the section cited above in one of one posting requirements, which poses/posed a potential health, safety or personal rights risk to persons in care. The LPA observed the telephone for the health deparment or the child passanger restrain system were not posted as required.
	POC Due Date: 04/18/2024
	Plan of Correction
1 2 3 4	The licensee stated child passanger restrain and phone number to the health department would be posted. A photograph of proof of correction will be emailed to the LPA.

Type B

Section Cited

CCR

101238.3(b)

Indoor Activity Space

(b) The floors of all rooms shall have a surface that is safe and clean. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in one of one classrooms, which poses/posed a potential health, safety or personal rights risk to persons in care. The LPA observed dirt and other substance accumulated on walls and floor. The substance, which appeared to be dried liquid, left dripping marks on the walls.
	POC Due Date: 04/18/2024
	Plan of Correction
1 2 3 4	The licensee stated they will clean the classroom and remove the substance dripping on the walls.

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: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo Silva	TELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024

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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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MONTESSORI HOUSE OF CHILDREN	FACILITY NUMBER: 300600679
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101238.4(a)

Storage Space

(a) The licensee shall ensure that each child has an individual permanent or portable storage space for his/her clothing, personal belongings and/or bedding. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in three of three children present, which poses/posed a potential health, safety or personal rights risk to persons in care. The LPA observed the children's backpacks were on the floor. The backpacks contained the water bottles and according to the licensee also the children's lunch boxes.
	POC Due Date: 04/18/2024
	Plan of Correction
1 2 3 4	The licensee stated the will have the children store their belongings in a spaced reserved for their belongings.

Type B

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
1 2 3 4	Based on observation the licensee did not comply with the section cited above in one of one cleaning compound, which poses/posed a potential health, safety or personal rights risk to persons in care. The LPA observed a green cylinder of "Comet" under the sink, accessible to children in care.
	POC Due Date: 04/18/2024
	Plan of Correction
1 2 3 4	The licensee stated the cleaning compound and made it inacessible. The licensee stated cleaning compounds will be stored inaccessible to children.

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: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo Silva	TELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024

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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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MONTESSORI HOUSE OF CHILDREN	FACILITY NUMBER: 300600679
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101230(a)(2)

Activities/Napping

(a) Each center shall provide a variety of daily activities designed to meet the needs of children in care, including but not limited to: (2) Rest and relaxation. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interviews, the licensee did not comply with the section cited above in three of three children present, which poses/posed a potential health, safety or personal rights risk to persons in care. The LPA inquired about nap/relaxation time. The director stated the children don't nap because their parents don't want them to take a nap. A child under 5 was present in care at the time of inspection. The facility doesn't have a scheduled nap time.
	POC Due Date: 04/18/2024
	Plan of Correction
1 2 3 4	The licensee stated she will provide a cot/mat and an opportunity to nap to children in care including children under 5 years.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo Silva	TELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024

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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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MONTESSORI HOUSE OF CHILDREN	FACILITY NUMBER: 300600679
	VISIT DATE: 03/18/2024

NARRATIVE

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The children’s belongings were observed to be on the floor; storage for the children’s belongings was unused/available (see 809D). During the inspection the LPA asked about napping/relaxation time. The licensee stated the children don’t nap because the parents don’t want them to take a nap. A child under 5 years of age was present. The licensee stated the facility doesn’t have a nap/relaxation time scheduled for the children.

OUTDOOR INSPECTION. The LPA inspected the outdoor areas. The playground was enclosed by a fence at least four feet in height and is in good repair. At the time of inspection, the surface of the outdoor activity area was not maintained or free of any observable hazards. The LPA observed what appeared to be cat feces in the playground near the swings and near the monkey bars. The licensee observed clumps of dirt typical of buried cat feces. Flies were observed flying around the feces and the clumps of sand. Children were observed playing around the cat feces, including one child who was sitting on the sand where feces were observed near the monkey bars. A type A citation was issued (See 809D). The areas around and under high climbing equipment, swings, slides, and other similar equipment were cushioned with material that absorbs falls but needs maintenance (Technical violation issued). The outdoor equipment and toys are in good repair and free of sharp edges.

PERSONNEL RECORDS. Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, a person shall not be employed or volunteer at a child day care center if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis, measles for staff members were reviewed and within compliance. Beginning March 31, 2018, H&S Code 1596.8662 requires all directors and employees to complete mandated reporting training and to renew the training every two years. Staff files were reviewed for compliance. At least one staff present has a valid EMSA approved Pediatric CPR/First Aid certifications.

CHILDREN’S RECORDS. Children's records were reviewed for compliance. Each client has a separate, complete, and current record. Sign in/out procedure was reviewed for compliance. Transportation is offered to clients.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo Silva	TELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024

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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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MONTESSORI HOUSE OF CHILDREN	FACILITY NUMBER: 300600679
	VISIT DATE: 03/18/2024

NARRATIVE

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The Incidental Medical Services (IMS) policy was discussed. A link to PIN 22-02-CCP was provided here: PIN 22-02-CCP: Best Practices Related to the Provision of Incidental Medical Services in Child Care Centers and Family Child. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

The Director was informed that Licensing Quarterly Updates are available at www.cdss.ca.gov Director may request to be added to an email list to receive a Quarterly Update by contacting the Child Care Advocate at childcareadvocatesprogram@dss.ca.gov or at www.cdss.ca.gov
LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

Information on the additional nutrition training, immunization requirements for children, and Health Schools Act (http://www.cdpr.ca.gov/docs/pestmgt/schoolipm.htm) were provided. The facility representative was informed, and website given, about the California Child Care Disaster Plan has been posted to the UCSF California Childcare Health Program website: cchp.ucsf.edu/content/disaster-preparedness Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org A copy of the California Department of Social Services Lead Information Brochure was explained and provided to the facility representative.

LEAD TESTING: Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for
drinking and food preparation) for lead contamination before January 1, 2023, and then every
5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. There is no record of a lead test being conducted at the facility on the Water Board website. Citation issued (See 809D).

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo Silva	TELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024

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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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MONTESSORI HOUSE OF CHILDREN	FACILITY NUMBER: 300600679
	VISIT DATE: 03/18/2024

NARRATIVE

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CRIMINAL RECORD CLEARANCE: The director understands that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to the initial presence in a licensed child care facility. Violation of this requirement will result in a citation of a deficiency and civil penalties of one hundred dollars ($100) per violation per day for a maximum of five (5) days. Subsequent violations within a twelve (12) month period will result in a civil penalty of one hundred dollars ($100) per violation per day for a maximum of thirty (30) days in accordance with Section 1596.871 of the Health and Safety Code.

The facility was not in compliance. Violations of the California Code of Regulations, Title 22, Division 12 were observed, discussed, and cited at the time of the visit. The following violations of the California Code of Regulations, Title 22; Division 12, were observed and cited today: 101223(a)(2) Personal Rights, 101238(a) Buildings and Grounds, 1596.954 Licensure Requirements, 1597.16(a)(1) Lead Testing, 101169(d)(18) Application for License, 101238.3(b) Indoor Activity Space, 101238.4(a) Storage Space, 101238(g) Buildings and Grounds, 101230(a)(2) Activities/Napping.

LPA A. Silva informed licensee Shirani Perera that this licensing report dated 3/18/2024 documents 2 “Type A” citation(s). Type A citation(s) must be posted for 30 consecutive days during the hours that children are in care as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. LPA A. Silva further informed licensee Shirani Perera that a copy of this licensing report must be provided to parents or guardians of all clients currently enrolled by the next business day or by the next day the children are in care. A copy of this report must be provided to the parents or guardians of all newly enrolled clients for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224) form, or another written equivalent statement, must be placed in the child's file for verification of receipt of the report.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo Silva	TELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024

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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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MONTESSORI HOUSE OF CHILDREN	FACILITY NUMBER: 300600679
	VISIT DATE: 03/18/2024

NARRATIVE

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Appeal Rights and deficiencies were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. A notice of site visit was given and must remain posted for 30 days. Exit interview was conducted and the report was reviewed with the director.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo Silva	TELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024

LIC809 (FAS) - (06/04)

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