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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371290
Report Date: 07/29/2021
Date Signed: 07/29/2021 03:38:03 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:LITTLE THINKERS MONTESSORI ACADEMYFACILITY NUMBER:
304371290
ADMINISTRATOR:KALUGAMPITIYA, LILAMANIFACILITY TYPE:
830
ADDRESS:34240 CAMINO CAPISTRANOTELEPHONE:
(949) 488-7939
CITY:CAPISTRANO BEACHSTATE: CAZIP CODE:
92624
CAPACITY:7CENSUS: 5DATE:
07/29/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Lilamani Kalugampitiya - Director TIME COMPLETED:
03:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Ryan Chan conducted an onsite inspection for the purpose of a 1-year required annual inspection. LPA and director toured the facility inside and outside and the floor and yard plan (LIC 999) were verified. Census was taken in individual classrooms. The overall census observed was 2 staff and 5 infants. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. Facility hours are 7a.m.- 6p.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.

During the inspection of the indoor activity space, items which could pose a danger to children (detergents, cleaning compounds, and medications) were observed to be stored out of the reach of children. Poisons/Hazardous Items are not kept on the premises. Parents provide milk for children and facility can provide additional milk if needed. Food prep areas are clean and sanitary. Food is properly stored. 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 sippy cups with their name which is refilled as needed. The children's bathrooms are clean and sanitary. Children nap on cots/mats or cribs, bedding is stored individually and is taken home weekly to be washed by parents at end of week. The facility has conducted an emergency drill within the past six months. Director states the fire alarm and smoke detector is a combination unit and if triggered will notify a company who will send paramedics and the fire department. The facility has a working fire extinguisher. Facility met all posting requirement. The California Child Passenger Safety Law was posted by the entrance of the facility.

Staff files were reviewed for staff present during the facility inspection on this date, 3 staff files were reviewed including directors file. Health screening and immunizations as required were reviewed.
(Continued on page 2)
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Ryan Joseph ChanTELEPHONE: (714) 287-0708
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 6
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: LITTLE THINKERS MONTESSORI ACADEMY
FACILITY NUMBER: 304371290
VISIT DATE: 07/29/2021
NARRATIVE
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· Pacifiers may be used as long as they do not have items attached to them
· Infants should not be swaddled or have any items covering them while sleeping
· The temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold

PIN 21-08-CCLD announces the resumption of on-site mandated regular inspections, also known as “annual inspections. Please post/keep this PIN in the facility/home where parents, authorized representatives, and children in care can easily access it and distribute the Companion Guide PIN Summary for Children in Care Fact Sheet (located at the end of the PIN) to their authorized representative. LPA provided (licensee/director) a copy of the PIN.

Based on LPAs records reviewed the following violation was observed and is being cited: Health and Safety Code Section 1596.8662(4)(b)(1) and California Code of Regulations, Title 22, Section 101419.2(b)(2), see attached LIC 809D.

1596.8662
(4) (b) (1)   On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

101419.2 Infant Needs and Services Plan
(b) (2) Infants up to 12 months of age shall have a completed Individual Infant Sleeping Plan [LIC 9227 (3/20)], which is incorporated by reference.

Continued on page 5
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Ryan Joseph ChanTELEPHONE: (714) 287-0708
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: LITTLE THINKERS MONTESSORI ACADEMY
FACILITY NUMBER: 304371290
VISIT DATE: 07/29/2021
NARRATIVE
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Page 5

An Inspection and exit interview was completed with the director. 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.

A Notice of Site Visit was provided to the director and was informed 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 LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Ryan Joseph ChanTELEPHONE: (714) 287-0708
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: LITTLE THINKERS MONTESSORI ACADEMY
FACILITY NUMBER: 304371290
VISIT DATE: 07/29/2021
NARRATIVE
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Beginning September 1, 2016, Health and Safety (H&S) 1596.7995(a)(1) states, a person shall not be employed or volunteer at a childcare center if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis, measles for staff were reviewed and within compliance. Beginning March 31, 2018, H&S Code 1596.8662(b)(1) requires all staff to complete mandated reporting training, and to renew the training every two years, staff #2 did not have proof of completion of mandated reporter training and was not in compliance. At least one staff member present possesses current EMSA approved Pediatric CPR/First Aid certifications, which expires 09/2022.

The director was informed that the Criminal Record Statement (LIC 508) has been updated, and the facility must now use the new form with revised date 7/20. The director was also informed that the LIC 508 must be submitted with all Criminal Background Clearance.

Children's records were reviewed, and there was a separate, complete and current record for each child. A random sample of 5 children's files were reviewed for documentation of the child’s name, address, and telephone number of the child’s authorized representative and of relatives or others that can assume responsibility for the child if the authorized representative cannot be reached when necessary (LIC 700) and a medical assessment. Other documents reviewed were the needs, services, and feeding plan. LPA observed (2 infants) from 0-12 months, both infants (Child #2 and #5) did not have form LIC 9227 Individual Infant Sleeping Plan in their files, facility was not in compliance. Sign in/out procedure was reviewed for compliance. The person who signs the child in and out uses their full legal signature and records the time of the day.

Incidental Medical Services (IMS) policy was discussed. 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

The outdoor activity space was inspected for compliance. The playground was enclosed by a fence at least four feet in height. (Continued on page 3)
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Ryan Joseph ChanTELEPHONE: (714) 287-0708
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: LITTLE THINKERS MONTESSORI ACADEMY
FACILITY NUMBER: 304371290
VISIT DATE: 07/29/2021
NARRATIVE
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The surface of the outdoor activity space was well maintained and free of hazards. The cushioning material (rubber floor) around the climbing equipment, swings, slides and other similar equipment appeared to be enough to absorbs falls. There is drinking water available to children outdoors by sippy cups with their name which is refilled as needed. The outdoor equipment and toys were in good repair and free of sharp edges. There are no bodies of water present at the facility. The facility grounds were safe, sanitary and in good repair.
The director was informed that Licensing Quarterly Updates are available at www.ccld.ca.gov director may request to be added to an email list to receive a Quarterly Update by contacting the Child Care Advocate at childcareadvocatesprogram@dss.ca.gov or at www.ccld.ca.gov
LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian
Information on the additional nutrition training, immunization requirements for children, and Health Schools Act (http://www.cdpr.ca.gov/docs/pestmgt/schoolipm.htm) were provided. The director was informed, and website given, about the California Child Care Disaster Plan has been posted to the UCSF California Childcare Health Program website: cchp.ucsf.edu/content/disaster-preparedness Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org A copy of the California Department of Social Services Lead Information Brochure was explained and provided to the facility representative.
A copy of the 2016 “A Child Care Providers Guild to Safe Sleep” was provided to the director.
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
· Always place infants on their backs for sleeping
· Use only a tight-fitting sheet on the crib or play yard mattress
· Do not hang any items from the crib or above the crib
· Keep all items, including blankets, out of the crib or play yard
Continued on page 4
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Ryan Joseph ChanTELEPHONE: (714) 287-0708
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: LITTLE THINKERS MONTESSORI ACADEMY
FACILITY NUMBER: 304371290
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/29/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/12/2021
Section Cited

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1596.8662(4)(b)(1) On or before March 30, 2018...is a licensed child care provider, administrator, or employee...shall complete the mandated reporter training...shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
This requirement was not met as evidenced by:
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Based on records reviewed Staff #2 did not have proof of mandated reporter training on file which poses a potential risk to the health and safety of children in care.
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Type B
08/12/2021
Section Cited

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101419.2 Infant Needs and Services Plan
(b) (2) Infants up to 12 months of age shall have a completed Individual Infant Sleeping Plan [LIC 9227 (3/20)], which is incorporated by reference.
This requirement was not met as evidenced by:
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Based on records reviewed Child #2 and #5 did not have form LIC 9227 Individual Infant Sleep Plan in their file
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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 LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Ryan Joseph ChanTELEPHONE: (714) 287-0708
LICENSING EVALUATOR SIGNATURE:
DATE: 07/29/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/29/2021
LIC809 (FAS) - (06/04)
Page: 6 of 6