304370936-7-20-2023-06-CC-PRIS-CTWVGS-20230720162602

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304370936
Report Date: 07/20/2023
Date Signed: 07/20/2023 04:27:41 PM

Document Has Been Signed on 07/20/2023 04:27 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:	SHINING STAR MONTESSORI PRESCHOOL		FACILITY NUMBER:	304370936
ADMINISTRATOR:	THAMOTHERAM, SAROJNI		FACILITY TYPE:	850
ADDRESS:	1239 NORTH HARBOR BLVD.		TELEPHONE:	(714) 312-9493
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92801
CAPACITY:	60	CENSUS: 8	DATE:	07/20/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:10 PM
MET WITH:	Vivian Maeda Teacher and Sarojni Thamotheram, Director		TIME COMPLETED:	04:50 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	Licensing Program Analyst (LPA) P Rivas conducted an unannounced annual inspection and met with Teacher Vivian Maeda who allowed entrance. Director Sarojni Thamotheram was inside facility caring for 8 napping children. Ms. Maeda called Administrator who advised that Director would handle inspection. LPA was assisted by Ms. Maeda as Ms. Sarojni was providing Direct care. This facility also has a Toddler Option Program but there are currently no children attending the toddler option program. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. Facility hours are 7:30 a.m.to 6:00p.m., Monday through Friday. A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Due to time constraints only the physical plant was toured. The facility is a two story building. The first floor is used for children's use. The second floor is only accessible to teachers and directors. Upstairs consisted of kitchen, office, storage rooms. First floor consisted of classrooms, a separate toddler option room. Outside playgrounds for both pre school and toddlers. Toxic are stored out of the reach of children. Poisons/Hazardous Items are not kept on the premises. Food is both brought from home and prepared in the facility. Food prep areas were clean and sanitary. Floors, equipment, and furniture were clean and were observed to be in good repair and free of sharp edges. There is drinking water available to children indoors by water bottles and drinking fountains and outside water

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat Rivas	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SHINING STAR MONTESSORI PRESCHOOL	FACILITY NUMBER: 304370936
	VISIT DATE: 07/20/2023

NARRATIVE

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Documentation of an emergency drill within the past six months was not available. Citation will be issued under 101174(d) Disaster and Mass Casualty Plan. The facility has has working carbon monoxide and smoke detectors. Fire extinguishers were last serviced 07/08/22 which does not meet State Fire Marshall Requirements. Facility met all posting requirement. The California Child Passenger Safety Law was posted by the entrance of the facility.

The outdoor activity space was inspected for compliance. The playground was enclosed by a fence at least four feet in height.. The cushioning is sand and is around the climbing equipment, such as swings, slides and other similar equipment appeared to be enough to absorbs falls. Drinking water in the outdoor activity space is provided by water bottles and disposable water bottles. The outdoor equipment was not in good repair. There are no bodies of water present at the facility. The facility grounds were safe, sanitary and in good repair. A citation is being issued under 101238.2 Outdoor Activity Space.
Administrator reported that Lead testing is scheduled but has not been completed. Citation will be issued
under 1597.16.(a)(1) Lead Testing.

In the areas that were evaluated, the following deficiencies are cited under the California Code of Regulations, Title 22, Division 12 ; on 809 (d)

An Inspection and exit interview was completed with Director.Sarojni Thamotheram and Vivian Maeda Teache The report was reviewed and discussed. 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.

The facility representative, Sarojni Thamotheram, DirectorVivian Maeda Teache was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. The “Notice of Site Visit” must be posted on or adjacent to the door. Failure to post will result in Civil Penalties of $100.00.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat Rivas	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

LIC809 (FAS) - (06/04)

Page: 2 of 6

Document Has Been Signed on 07/20/2023 04:27 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SHINING STAR MONTESSORI PRESCHOOL	FACILITY NUMBER: 304370936
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/20/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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 interview with Director, the licensee did not comply with the section cited above Director advised that there has been no tlead testing completed that they have scheduled an appointment which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/28/2023
	Plan of Correction
1 2 3 4	Licensee will have water tested for Lead by plan of correction date and advise LPA when testing is completed (patricia.rivas@dss.ca.gov)

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: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat Rivas	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

LIC809 (FAS) - (06/04)

Page: 6 of 6

Document Has Been Signed on 07/20/2023 04:27 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SHINING STAR MONTESSORI PRESCHOOL	FACILITY NUMBER: 304370936
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/20/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101174(d)

Disaster and Mass Casualty Plan (d) Disaster drills shall be conducted at least every six months and shall be documented This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview a disaster drill log could not be found, the licensee did not comply with the section cited above in in having disaster drill conducted and documented which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/27/2023
	Plan of Correction
1 2 3 4	Licensee will have disaster drill conducted and documented and send copy to LPA Rivas by Plan of correction date. Information can be emailed to patricia.rivas@dss.ca.gov

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: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat Rivas	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

LIC809 (FAS) - (06/04)

Page: 3 of 6

Document Has Been Signed on 07/20/2023 04:27 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SHINING STAR MONTESSORI PRESCHOOL	FACILITY NUMBER: 304370936
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/20/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101238.2(d)(1)

Outdoor Activity SpaceThe surface of the outdoor activity space shall be maintained 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 review of outside playground equipment the preschool play structure had peeling paint throughout structure, the peeling paint was easily pulled off structure and middle swing was ripped which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/21/2023
	Plan of Correction
1 2 3 4	licensee will have structure repaired and will have swing repaired or replaced by plan of correction date. A picture can be sent to LPA showing correction. Picture can be sent to LPA via email by plan of correction date (patricia.rivas@dss.ca.gov)

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: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat Rivas	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

LIC809 (FAS) - (06/04)

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