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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300600679
Report Date: 05/13/2025
Date Signed: 05/13/2025 03:28:20 PM

Document Has Been Signed on 05/13/2025 03:28 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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:MONTESSORI HOUSE OF CHILDRENFACILITY NUMBER:
300600679
ADMINISTRATOR/
DIRECTOR:		GUNAWARDENA, MAUREENFACILITY TYPE:
850
ADDRESS:1239 SOUTH MAGNOLIATELEPHONE:
(714) 761-3109
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 26TOTAL ENROLLED CHILDREN: 26CENSUS: 1DATE:
05/13/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Director GunawardenaTIME VISIT/
INSPECTION COMPLETED:
03:34 PM
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On 5/13/25, Licensing Program Analyst (LPA) Silva conducted an unannounced POC visit. LPA met with Director Gunawardena and Administrator Shirani Perera and toured the facility. The census was 1 child. The facility was operating within its licensed capacity and within compliance of staff-to-child ratios. 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 exemptions.

On 5/7/2025, the LPA identified immediate risks to the health, safety, and personal rights of the children in care. The deficiencies were cited as follows:

101238(a) Buildings and Grounds due to soiled cat litter being accessible to children under the sink in the children's restroom. The cat litter was accessible to children in care who were present at the time of the inspection. During today’s visit, the LPA inspected the indoor activity area and observed the cat litter box had been removed from the indoor activity areas and placed in a space of the property Ms. Perera stated is not used for child care activities.

101238.2(d)(2) Outdoor Activity Space due to cat feces in various places of the outdoor activity area, including the sand boxes and the grassy areas. During today’s visit, the LPA inspected the outdoor activity area and observed the area was littered with feces in the sand boxes and grassy areas. The director stated the gardener was at the facility on Monday and cleaned it up. Ms. Perera stated the staff inspected the area in the morning but did not log the inspection.

NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Archibaldo Silva
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/13/2025
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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MONTESSORI HOUSE OF CHILDREN
FACILITY NUMBER: 300600679
VISIT DATE: 05/13/2025
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101223(a)(2) Personal Rights because child #1 (C1) was observed using the outdoor activity area before the cat feces were removed. During today’s visit, the LPA observed children in the outdoor activity area, including C1. Ms. Perera stated the outdoor activity area had been cleaned by a gardener and tarps were requested from the gardener to cover the sand boxes. The director stated the gardener cleans on Mondays. During today's visit, there were feces in the outdoor area.

The facility was not in compliance. The plans of correction for the deficiencies associated with CCR, Title 22, Sections 101238.2(d)(2) Outdoor Activity Space and 101223(a)(2) Personal Rights were not been completed by the due date. A civil penalty was issued during the visit.

A new LIC9224 was issued to Ms. Pepera. The LPA explained that the parent’s of children currently enrolled and parents of children who enroll in the next 12 months must received a copy of the licensing report dated 5/7/2025 and a signed copy of the LIC9224 placed in the children’s files.

The facility representative received a copy of the Appeal Rights (LIC 9058 01/16), a copy of this licensing report, and their signature on this form acknowledges receipt of these rights. The appeal rights were discussed. All appeals must be in writing and received by the Regional Office within 15 business days. First-level appeals should be sent to the Regional Manager at the address listed above. The representative understands that the Notice of Site Visit shall remain posted for 30 days

End.

NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Archibaldo Silva
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025
LIC809 (FAS) - (06/04)
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