304371150-8-29-2019-06-CC-CNGN-BFHUWD-20190829155633

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371150
Report Date: 08/29/2019
Date Signed: 08/29/2019 03:56:42 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 COSTA MESA		FACILITY NUMBER:	304371150
ADMINISTRATOR:	MAIDA, CECILE		FACILITY TYPE:	830
ADDRESS:	2950 MCCLINTOCK WAY		TELEPHONE:	(714) 966-0303
CITY:	COSTA MESA	STATE: CA	ZIP CODE:	92626
CAPACITY:	8	CENSUS: 0	DATE:	08/29/2019
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Director, Cecile Maida		TIME COMPLETED:	04:30 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	Licensing Program Analysts (LPA) Cindy Nguyen conducted a case management inspection at the facility due to the facility has requested to increase the capacity and add a toddler option component to the existing infant license. Facility is currently licensed for 8 infants in Room 2 from 12 months to 24 months of age from 7:00 AM to 6:00 PM, Monday through Friday and seeking to add 4 more infants, changing the age group from 6 weeks to 18 months of age in Room 4 and 12 toddlers ages 18 to 36 months old in Room 2 to the infant license with a total capacity of 24 by adding classroom number 4. LPA met with director, Cecile Maida. There were no children present during the inspection due to school not beginning until Tuesday September 3, 2019. A temporary partition is in place currently and the permanent partition will be in place in two weeks. LPA toured the entire facility indoors and outdoors and the following measurements were taken: Indoor: Room 2 (Toddler Option Component): 424 square feet/35 square feet = 12 children Room 4: (Infant: 6 weeks to 18 months): 421 square feet = 12 children Total: 845 square feet/35 square feet = 24 children Toilets and sinks: Toilets 2 X 15 = 30 children Sinks 2 X 15 = 30 children Outdoor: (Previously measured on 4/28/17) 1688 square feet/35 by 75 = 22 children Fire clearance from the city of Costa Mesa Fire Prevention has been received and approved for requested capacity. A waiver was requested to use infant and toddler children for the infant outdoor yard on a rotating basis. Continued on Page 2

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy Nguyen	TELEPHONE: (714) 296-3608
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2019

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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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: INT'L CHRISTIAN MONTESSORI ACADEMY OF COSTA MESA	FACILITY NUMBER: 304371150
	VISIT DATE: 08/29/2019

NARRATIVE

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The following was observed:
· There is a designated napping area surrounded by a 4 ft wall with sufficient infant napping equipment.
· The infant indoor and outdoor space is physically separate from the preschool.
· Classroom are adequately equipped with age and size appropriate furniture and equipment.
· Drinking water is available for inside and outside drink.
· The changing table is within arm’s reach of a sink.
· The changing table is padded with raised sides.
· Clean bedding will be used daily.
· Playground is fully enclosed by an appropriate fence.
· Outdoor activity area is supplied with age and size appropriate equipment.
· Adequate shade is provided by trees.
· Snacks are provided by the facility and lunch is provided by the parents.
· The staff office will serve as the isolation area for ill children until parents arrive.
· A separate staff restroom is available for adults on site.
· Medication will be stored in the kitchen and is inaccessible to children.
· First Aid kit is complete.
· Sign in/Sign out procedure was reviewed and meets regulation requirements. This facility utilizes an electronic sign in/out system.
· There is a working smoke detector, carbon monoxide detector and fire extinguisher that meet statutory requirements.

Director was notified about staff-infant ratio requirements, direct visual supervision requirements, emergency/disaster drills, posting requirements, children records, mandated child abuse and injury/ death reporting, mandated reporter training, immunization requirements against measles, pertussis, and influenza and fingerprint clearance requirements. Facility representative was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov. Continued on Page 3

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy Nguyen	TELEPHONE: (714) 296-3608
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2019

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: INT'L CHRISTIAN MONTESSORI ACADEMY OF COSTA MESA	FACILITY NUMBER: 304371150
	VISIT DATE: 08/29/2019

NARRATIVE

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A hard copy of the 2016 “A Child Care Providers Guide to Safe Sleep” and Department of Social Services Lead Information Brochure were explained and provided to the applicant.

The following electronic links were also provided:
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
AAP:https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

This facility provides Incidental Medical Services -IMS. LPA reviewed storage of medication, equipment/supplies, and reviewed children's, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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 publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Based on today’s measurement and the sink & toilet availability, center has sufficient activity space to support the capacity requested of 12 infants and 12 toddlers with a total capacity of 24 children. This facility meets licensing requirements for the issuance of license to care for 24 children, 12 toddlers ages 18 to 36 months old and 12 infants 6 weeks to 18 months of age 7:00 AM to 6:00 PM, Monday through Friday. File will be submitted for a final in office review prior to issuance of a license.

There are no Title 22 deficiencies cited during today's inspection.

Exit interview was conducted with Director, Cecile Maida. Report reviewed and discussed. Notice of Site Visit was posted during the visit. 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. Appeal rights provided and explained. The facility representative was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights.

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy Nguyen	TELEPHONE: (714) 296-3608
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2019

LIC809 (FAS) - (06/04)

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