300606148-5-13-2024-06-CC-PRIS-D58UBJ-20240513152625

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300606148
Report Date: 05/13/2024
Date Signed: 05/13/2024 03:29:02 PM

Document Has Been Signed on 05/13/2024 03:29 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	INT'L CHRISTIAN MONTESSORI ACADEMY OF ORANGE		FACILITY NUMBER:	300606148
ADMINISTRATOR:	EMBRADOR, ALLISON		FACILITY TYPE:	850
ADDRESS:	1539 MAYFAIR		TELEPHONE:	(714) 997-8242
CITY:	ORANGE	STATE: CA	ZIP CODE:	92867
CAPACITY:	60	CENSUS: 3	DATE:	05/13/2024
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	01:55 PM
MET WITH:	Ms. Inayat Bergum, Licensee		TIME COMPLETED:	04:00 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	On May 13, 2024 at 1:55pm, Licensing Program Analyst (LPA), P. Rivasconducted an unannounced Case Management inspection for a decrease in capacity. Upon arrival, LPA met with Licensee, Inayat Bergum. Licensee is requesting to be licensed for 13 preschool children in Room #1. The building has two addresses and licensee will only be using Room #1 for the address of 1539 Mayfair Orange. This facility will be sharing playground, office area, kitchen and staff bathroom with Bright Bubbles Academy 304371665 which has an address of 1535 E.MAYFAIR ROOM, 2,3,& 4. Licensee Bergum is requesting capacity of 13 preschool children ages 2years old to 6years old, in classroom #1. Hours of operation will be Monday- Friday 7:30am to 4:30pm. Present during today’s inspection were 3 children with 1 staff. Appropriate ratios and supervision were observed. All indoor and outdoor activity space utilized for the children was inspected today. LPA informed Ms. Bergum that staff are required to maintain direct visual supervision of the children at all times during indoor and outdoor activities. LPA continued to tour the facility and measured indoor and outdoor activity space. Total indoor activity space measured at 1140 square feet which is

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (916) 936-5444
LICENSING EVALUATOR NAME: Pat Rivas	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2024

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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: INT'L CHRISTIAN MONTESSORI ACADEMY OF ORANGE	FACILITY NUMBER: 300606148
	VISIT DATE: 05/13/2024

NARRATIVE

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sufficient to accommodate the requested capacity of 13 Children. LPA observed all indoor activity space to be complete with safe, age-appropriate furniture and equipment, including tables, chairs, cubbies, napping cots/mats, bookshelves, and other activity supplies for the children. Drinking water is brought by children and facility also has a water spiket that facility brings in containers of water. LPA observed all hazardous items to be inaccessible to children. There are no bodies of water or weapons on the property. Smoking is not allowed in the facility. Fire clearance was granted 03/06/2024 with special condition of ; Fire clearance approved under the above noted conditions; International Christian Montessory Academy shares a building with Bright Bubbles Academy so long as the building's total client capacity doesn't change from 60 clients. Neither program will be required to change occupancy types.

LPA observed a total of 2 sinks and 2 toilets available for children’s use. These are sufficient to accommodate the requested capacity of 13 children.

The facility currently has a fully fenced playground area. Fencing is a brick wall and is at least four feet high. The total square footage for all the outdoor activity space is 6097 square feet, which is sufficient to accommodate the requested capacity. However the facility will be sharing the pre school yard with Bright Bubbles Academy 304371665. A waiver will be requested. Shade is provided via awnings.

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (916) 936-5444
LICENSING EVALUATOR NAME: Pat Rivas	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2024

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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: INT'L CHRISTIAN MONTESSORI ACADEMY OF ORANGE	FACILITY NUMBER: 300606148
	VISIT DATE: 05/13/2024

NARRATIVE

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There are sufficient outdoor age-appropriate toys and play equipment available on the playground. There is a climbing structure on the playground for children ages 2 to 6 years old which is properly anchored. There is adequate cushioning in fall zones of climber provided by sand.

Drinking water is available via water spicket that facility buys water for use and children bring their own water bottles. LPA observed all hazardous items on the playground to be inaccessible to children. Licensee Ms. Bergum was reminded that any changes to the facility must be reported to and approved by Community Care Licensing.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP).

The following corrections are needed prior to the issuance of the license:
1. Request a waiver for shared playground
2. Final review of documents.

Licensee, Ms. Bergum understands that all proof of corrections must be provided to the Department within 30 days, or the application may be denied.

Licensee was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California. “

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (916) 936-5444
LICENSING EVALUATOR NAME: Pat Rivas	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2024

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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: INT'L CHRISTIAN MONTESSORI ACADEMY OF ORANGE	FACILITY NUMBER: 300606148
	VISIT DATE: 05/13/2024

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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.
A notice of site visit was given to licensee Ms. Bergum] and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. “

Exit interview conducted and report was reviewed with the licensee, Ms. Bergums

“

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (916) 936-5444
LICENSING EVALUATOR NAME: Pat Rivas	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2024

LIC809 (FAS) - (06/04)

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