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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270294
Report Date: 03/11/2025
Date Signed: 03/11/2025 01:58:21 PM

Document Has Been Signed on 03/11/2025 01:58 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:NORTHWOOD MONTESSORI SCHOOL OF IRVINEFACILITY NUMBER:
304270294
ADMINISTRATOR/
DIRECTOR:		FUKUNAGA, LISAFACILITY TYPE:
850
ADDRESS:12100 YALE COURTTELEPHONE:
(714) 508-0400
CITY:IRVINESTATE: CAZIP CODE:
92620
CAPACITY: 174TOTAL ENROLLED CHILDREN: 174CENSUS: 25DATE:
03/11/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Director, Lisa FukunagaTIME VISIT/
INSPECTION COMPLETED:
02:05 PM
NARRATIVE
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Page One

Licensing Program Analyst (LPA) Castro conducted a case management inspection to follow up on a self-reported unusual incident that was submitted to CCL Regional Licensing Office on 02/18/2025. It was reported by Cheryll Ruszat, Executive Director and Lisa Fukunaga, Director. According to director, Parent/Caretaker of Child 1 (C1) stated that Staff 1 (S1) allegedly dragged C1 to the bathroom and forced them to go potty.

During today's inspection a tour of the facility was conducted and census was taken: LPA observed 25 children in the classroom with 3 teachers. During today's inspection, the facility was observed operating within its licensed capacity and within compliance of staff to child ratios. A review of staff records 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.

Five (5) staff were interviewed. Five (5) children were also interviewed. All interviewed staff provided consistent statements about the following facility’s toileting, guidance and discipline policies. All interviewed staff also denied witnessing the alleged incident between C1 and S1. Five (5) children were interviewed. The five (5) interviewed children did not disclose any information to confirm the incident did occur.

Director provided LPA with a facility children's roster, personnel report, and other pertinent documents.

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SUPERVISORS NAME: Nguyen K Tran
LICENSING EVALUATOR NAME: Alma Castro
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2025
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: NORTHWOOD MONTESSORI SCHOOL OF IRVINE
FACILITY NUMBER: 304270294
VISIT DATE: 03/11/2025
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LPA was informed that C1 is no longer enrolled at the facility. According to director, a reminder on guidance and discipline policies will be conducted and mentioned during an upcoming staff meeting on Friday, March 14th, 2025.

In the areas that were evaluated, no deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit. Appeal Rights and deficiency 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 given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director, Lisa Fukunaga, Cheryll Ruszat and associate director, Rayann Palazzolo.

Appeal Rights and deficiency 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 given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director, Lisa Fukunaga

End of Report
SUPERVISORS NAME: Nguyen K Tran
LICENSING EVALUATOR NAME: Alma Castro
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025
LIC809 (FAS) - (06/04)
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