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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370185
Report Date: 06/28/2019
Date Signed: 06/28/2019 12:19:29 PM

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:INT'L CHRISTIAN MONTESSORI ACADEMY OF NEWPORTFACILITY NUMBER:
304370185
ADMINISTRATOR:RIVERO, MYRIAM S.FACILITY TYPE:
850
ADDRESS:2591 IRVINE AVENUETELEPHONE:
(949) 631-9749
CITY:COSTA MESASTATE: CAZIP CODE:
92627
CAPACITY:76CENSUS: 77DATE:
06/28/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Myriam RiveroTIME COMPLETED:
12:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) S. Hawkins made an unannounced visit to the facility for a case management meeting. LPA met with director Myriam Rivero and toured the facility. Census was taken in individual classrooms. The overall census observed was 8 preschool staff, 69 preschool children, and 2 toddler option staff and 8 toddler children. A review of staff criminal clearance records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During todays visit the facility report created on 5/8/19 Control Number: 06-CC-20190502095100 was amended and resigned to make the status Public. LPA also reviewed staffing ratio's in reference to napping and provided regulations as a reference guide.

No deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit.
An exit interview was completed. The report was reviewed and discussed. The facility representative was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Licensing office within 15 business days.

The facility representative was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. Failure to post will result in Civil Penalties of $100.00. The “Notice of Site Visit” must be posted on or adjacent to the door. Failure to post Type A reports for 30 day will result in a Civil Penalty of $100.00

SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Sherene HawkinsTELEPHONE: (714) 703-2821
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2019
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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