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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300606452
Report Date: 06/23/2022
Date Signed: 06/23/2022 01:05:05 PM


Document Has Been Signed on 06/23/2022 01:05 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:APPLETREE MONTESSORIFACILITY NUMBER:
300606452
ADMINISTRATOR:KELLY, ANTONIAFACILITY TYPE:
850
ADDRESS:25542 JERONIMO RDTELEPHONE:
(949) 770-2707
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:83CENSUS: 43DATE:
06/23/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Administrator Ms. Kelly, Antonia TIME COMPLETED:
01:15 PM
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Licensing Program Analyst conducted an unannounced Case Management (licensee initiated) inspection to remeasure the preschool yard.
LPA met with the Director Ms. Kelly Antonia, explained the purpose of the visit. LPA noted an error in the outdoor preschool yard measurement. Therefore the preschool yards were remeasured today.

Based on today's measurement facility can accommodate only 63 children in the two yards.

Total outdoor activity space: 4732'32 divided by 75 = 63'10 ( 63 children)
( Not 55 as earlier measured on 6/22/22)

Based on today's measurements facility has sufficient indoor space to accommodate 85 preschool age children and 24 toddlers with in the four assigned classrooms. Total capacity: 109 as requested
Facility shall request an Outdoor Waiver for Preschool children for a staggered schedule amongst the three classrooms.

Appeal Rights presented and a Notice of Site visit was posted.
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2022
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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