304371438-12-4-2020-06-CC-KDEI-BVYVMA-20201204153312

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371438
Report Date: 12/04/2020
Date Signed: 12/04/2020 03:33:30 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:	GAOWA MONTESSORI SCHOOL		FACILITY NUMBER:	304371438
ADMINISTRATOR:	MOERNO, ALEJANDRO		FACILITY TYPE:	850
ADDRESS:	1620 ADAMS AVENUE		TELEPHONE:	(714) 714-0055
CITY:	COSTA MESA	STATE: CA	ZIP CODE:	92626
CAPACITY:	120	CENSUS: 0	DATE:	12/04/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:40 AM
MET WITH:	Administrator Mr. Moreno, Alejandro		TIME COMPLETED:	03:40 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) Ketki Desai conducted an on site pre-licensing inspection at the proposed childcare center. LPA met with New Administrator Mr. Moreno, Alejandro who gave a tour of the new Child Care Center. The applicant has requested to provide care and supervision for 96 Pre-school age children 3 to 6 years of age, along with 24 Toddlers (18 months to 36 months) Monday through Friday, 7.00 am. to 6.00 PM. in the assigned eight classrooms and four additional Piano rooms. This is a new construction. A review of the Facility Personnel Report Summary 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. The children shall have access through the main entrance, at the back of the facility through the enclosed parking, once the cars are pulled in, there is small metal door with a buzzer, where each parent shall have the access code to gain entrance into the facility. Upon entering the facility, due to current pandemic situation, children shall be received at the entrance by the staff who are present at the reception area, temperatures are checked, hands are sanitized before they are taken to their classrooms. Parents sign them in at the entrance manually, currently outside visitors are not allowed in the facility. The facility also has a front entrance which can be accessed through the side gate upon entering the facility parking lot. 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

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2020

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: GAOWA MONTESSORI SCHOOL	FACILITY NUMBER: 304371438
	VISIT DATE: 12/04/2020

NARRATIVE

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Medication will be stored in the Director’s office in a locked cabinet and shall be administered by the Director or the Facility in charge, Emergency First Aid kits are stored in the classroom in assigned cabinets. Medication administration forms were reviewed.
Isolation area is the Director’s office area, an additional cot is in place for the sick child and the bathroom, located in the Director’s office area shall be used during this time.

The following were inspected in the indoor activity space:
· Classrooms are adequately equipped with age and size appropriate furniture and equipment
· Drinking water is available through water fountains in the hallway, water pitchers inside the classroom as well as individual sports bottles if they prefer
· Sign in/Sign out procedure was reviewed and meets regulation requirements (manual sign in and out)
· There is a working smoke detector, Fire Sprinkler system and fire extinguisher that meet statutory requirements. Being new construction, there is no natural Gas supply, hence Carbon Monoxide detectors are not required. Fire department has given the required approval.
· Cubbies available for storage of individual child’s personal belongings and/or bedding
· Napping equipment: Cots are used and are stored in the corner of each room on a rolling cart. Napping linens are brought from home
· Facility shall provide two snacks through the day, while lunch shall be brought from home and stored in their individual bags in their cubbies.

LPA discussed the posting requirements including, but limited to, the following:
· Facility License in public area (101160)
· Emergency Disaster Plan (LIC 610)
· Earthquake Preparedness Check List (LIC 9148)
· Parents’ Rights Poster (PUB 393)
· Personal Rights (LIC 613A)
· Menus
· Activity Schedule
· Notice of Site Visit (LIC 9213) and Type A deficiencies
· Plan of Corrections of Type A deficiencies
· Granted Waivers (available for review)
· Child Car Seat Law (PUB 269) and COVID Posters (Page 2 )

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2020

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: GAOWA MONTESSORI SCHOOL	FACILITY NUMBER: 304371438
	VISIT DATE: 12/04/2020

NARRATIVE

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The indoor activity space: There are six assigned Preschool rooms, two Toddlers rooms and three Piano rooms with surrounding two yards for the preschool children
Room # 1 44’33” X 22’08” = 978’81” / 35 = 27.96 (28 children)
Room #2 34’50” X 12’92” = 445’74” / 35= 12.73 (13 children)
Room # 3 19’42” X 21’92” = 425’69” / 35 = 12.16 (12 children)
Room # 4 36’ X 22’67 = 816’12” / 35= 23.31 (23 children)
Room # 5: 19’33” X 22’67” =438’21”/ 35= 12.52 (12 children)
Room # 8 65’42”X29’42” =1924’66/35 = 54.99 (55 children)
Piano Room # 1: 10’5” x 7’17” =75’29” /35 = 2.15 (2 children)
Piano Room # 2: 10’5” x 6’83” = 71’72” / 35= 2.0 (2 children)
Piano Room # 3: 10’5” X 7’17” = 75’29” / 35 = 2.15 (2 children)
Toddler room # 6: 21’92” X 19’42” = 425’69”/ 35 = 12.16 (12 Toddlers)
Toddler room # 7: 37’17” x 19’42” = 721’84”/ 35 =20.62 (21 children)

Total Indoor space: 6399’04" divided by 35= 182.83
(Capacity requested: 120)

Total sinks: 18 X 15= 270 (children) Total Toilets: 11 X 15= 165 (children)

LPA observed sink in the classrooms, there are gender specific bathrooms located surrounding the classrooms for easy access. Toddler classroom also has a changing station located within the arms distance and additional potty chairs are available for emergency purposes and facility plans to take potty trained toddlers. Toilets/ Urinals and sinks were observed to age appropriate in all the bathrooms observed.

The following were inspected in the outdoor activity space;
· Playground is fully enclosed by an appropriate fencing
· Drinking water is available outdoors by water fountains, individual sports bottles
· Outdoor activity space is supplied with age and size appropriate equipment, including climbing play structures and outdoor activity toys
· An adequate amount of cushioning material consisting of form is in place under the play structures
· Adequate shade is provided by shaded canopy and patio area.
· Side planter yard is designated for outdoor vegetable gardening activities (Page 3)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2020

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: GAOWA MONTESSORI SCHOOL	FACILITY NUMBER: 304371438
	VISIT DATE: 12/04/2020

NARRATIVE

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Outdoor space measurements: Facility has two designated yards. (Sand box/ three climbing structures/ walking trail)
Front yard: 110 X 76 = 8360
Side planter yard: 103 x 15’83” = 1630.49

Total Outdoor space: 9990.49 divided by 75 = 133.21

Based on the indoor measurements, sink and toilet availability, facility has enough space to accommodate the requested capacity for 120 children (96 Preschool and 24 toddlers) in the assigned classrooms.

Fire clearance received from City of Costa Mesa Fire Prevention office on 10/19/20 have approved the requested capacity of 120 children.

Facility Administrator is current on the required Immunization/ Pediatric CPR/ First training valid through September 2022 and have provided the completion certificate for the Preventive Health training (Nutrition and Lead component)

Facility is a new construction (2016) City Permit is obtained for verification. Water testing is not required being a new construction

LPA discussed with the applicant that all employees must have criminal record clearances associated to the facility prior to their presence in the facility, staff to child ratio requirements, direct visual supervision requirements, emergency/disaster drills, children records, mandated reporter training, and staff immunization requirements against measles, pertussis, and influenza. Applicant was advised the children's bedding must be stored individually and may not touch another children's bedding.

The applicant was given a pamphlet on Lead Exposure and was discussed with provider. Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org. The Chaptered Legislation for AB 2084 (Nutritious Beverages) is available to view on the website at: http://ccld.ca.gov/res/pdf/12APX-11.pdf
(Page 4)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2020

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: GAOWA MONTESSORI SCHOOL	FACILITY NUMBER: 304371438
	VISIT DATE: 12/04/2020

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Applicant was informed of Mandated Reporter Training for self and all assistants. Department web site form was given to down load forms, Title 22 regulations, and trainings on-line at www.ccld.ca.gov.

The applicant was also informed to visit the website for Quarterly Updates. The applicant was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov. or at www.ccld.ca.gov

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 applicant/facility representative 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

A copy of the 2016 “A Child Care Providers Guild to Safe Sleep” was provided to the applicant/facility representative.
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
Spanish: https//www.cdph.ca.gov/programs/SIDS/Documents/ChildCareProvSleepSPAN2011.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

The facility was following Title 22 requirements at the time of the inspection. Based on today’s measurements, and the sink and toilet availability, this center has enough activity space to support the capacity of 96 Preschool children and 24 Toddlers = 120 children.

A license will be issued for the capacity requested after a final review. The applicant will be notified if any additional information is required.

(Page 5)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2020

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: GAOWA MONTESSORI SCHOOL	FACILITY NUMBER: 304371438
	VISIT DATE: 12/04/2020

NARRATIVE

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Applicant was also advised, once licensed, the Notice of Site Visit must be posted for 30 days and if A violations are cited then the Licensing Report (LIC809 or 9099) must be posted by the Notice of Site Visit for a period of 30 days or $100 civil penalties will be assessed, and the report shall posted and copies provided to the parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file.

Exit interview was conducted and a copy of this report was provided to the Administrator/ Owner on this date.

An exit interview was completed. The report was reviewed and discussed.

Appeal Rights were discussed.

The applicant 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.

(End of report)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2020

LIC809 (FAS) - (06/04)

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