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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370344
Report Date: 07/30/2025
Date Signed: 07/30/2025 03:59:52 PM

Document Has Been Signed on 07/30/2025 03:59 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 COSTA MESAFACILITY NUMBER:
304370344
ADMINISTRATOR/
DIRECTOR:		MARIA TEELFACILITY TYPE:
850
ADDRESS:2950 MCCLINTOCK WAYTELEPHONE:
(714) 966-0303
CITY:COSTA MESASTATE: CAZIP CODE:
92626
CAPACITY: 41TOTAL ENROLLED CHILDREN: 41CENSUS: 21DATE:
07/30/2025
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:34 PM
MET WITH:Facility Representative/Director, Maria TeelTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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On 07/30/2025, Licensing Program Analyst (LPA) Deschampe conducted an unannounced Case Management - Legal/Non-Compliance inspection for the purpose of ensuring the facility is in compliance with California Title 22 Regulations, Health and Safety Codes and Stipulation and Waiver, and Order # 6622306102-B dated 04/10/2024. At 8:46 AM, LPA entered the facility and was met by facility representative/director, Maria Teel at 8:49 AM. LPA informed the facility representative/director purpose of the visit. LPA and the facility representative/director toured the facility inside and outside, and the floor and yard plan (LIC 999) were verified. Census was taken in individual classrooms. The census at 8:53 AM in the Red Room/Class 1, was 6 preschool age children and 1 staff. The census observed in the Blue Room/Class 3 at 8:49 AM was 15 preschool age children, 2 staff, and a third party employee. During the inspection, it was determined the facility is operating within its licensed capacity and within compliance of staff to child ratios. Facility hours are 7:30 AM - 5:30 PM, 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.

Facility representative/director was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or
NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Susan Deschampe
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/30/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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 COSTA MESA
FACILITY NUMBER: 304370344
VISIT DATE: 07/30/2025
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exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

During the inspection of the indoor activity space, items which could pose a danger to children (detergents and cleaning compounds) were observed to be stored and out of reach of children. Medications are centrally stored and in a space inaccessible to children. First-aid supplies were complete and stored in a location accessible to staff but inaccessible to children. Food is brought from the children’s homes. Food preparation areas were clean and sanitary. Food is properly stored. If necessary, the food is warmed up using the microwave in each classroom. Menus posted where they could be reviewed by parents/authorized representatives. Fixtures, furniture, equipment, and supplies were clean and observed to be in good repair, free of sharp edges, and age appropriate for all children enrolled in care. Children have access to drinking water via personal labeled water bottles and refilled with water dispensers in the classroom. The children's and staff bathrooms are safe and in sanitary operating condition. Children nap on cots which are properly stored. Bedding is brought from home and taken home every Friday, or as needed, to be washed by parents/authorized representatives. Children's personal items, including bedding is clean, stored individually, and in a labeled compartment. The facility has conducted an emergency drill within the past six months (06/20/2025). The facility has a working smoke detectors, carbon monoxide detectors, and there are 2 fire extinguishers on site. The facility maintains an indoor temperature within regulation (minimum of 68 degrees and maximum of 85 degrees F or, in extreme heat a maximum of 20 degrees less than the outside temperature). Facility met all waiver, exceptions, and posting requirements, including the California Child Passenger Safety Law, posted by the entrance of the facility.

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 licensee was informed and website given for the California Child Care Disaster Plan that 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. California Department of Social Services Lead Information Brochure was explained to the licensee.

NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Susan Deschampe
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2025
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 COSTA MESA
FACILITY NUMBER: 304370344
VISIT DATE: 07/30/2025
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This facility provides Incidental Medical Services – IMS. However, currently there is not a child enrolled who requires this service. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

The outdoor activity space was inspected for compliance. The playground was enclosed by a fence at least four feet in height. As noted in the Buildings and Grounds requirement, Section 101238(a): The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement was not met as evidenced by the wooden fence, for the perimeter of the preschool play yard. The fence has multiple holes from deterioration, exposing rusted screws/nails and splintering wood. The holes are approximately 6 inches from the ground, with a diameter of 2-3 inches (pictures taken). Facility representative/director will have the fence replaced. In the meantime, the facility representative/director will ensure the safety of children by making that area inaccessible to preschool age children (completed during the visit). The surface of the outdoor activity space was well maintained and free of hazards, with the exception of the breaks in cement where a structure was previously placed, which also does not meet the requirement. The cushioning material (sand) around the climbing equipment, slides and other similar equipment appeared to be enough to absorbs falls. The facility refills the sand every 6 months, or as needed. Staff inspects the sand filled areas in the morning for hazardous foreign materials. Drinking water in the outdoor activity space is provided by labeled water bottles and a water pitcher for refills. The outdoor equipment and toys were in good repair and free of sharp edges. There are no bodies of water present at the facility, or in the surrounding areas. The facility is a smoke free and firearm free zone.



LPA reviewed with the facility representative the LIC 311A, Records to Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

Staff files were reviewed for staff present during the facility inspection on this date, 6 of 6 staff files were
NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Susan Deschampe
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2025
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 COSTA MESA
FACILITY NUMBER: 304370344
VISIT DATE: 07/30/2025
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reviewed. Health screening and immunization as required were reviewed. Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, a person shall not be employed or volunteer at a child care center if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis and measles for staff were reviewed and within compliance. Flu declinations are current and have been signed and dated by staff. Beginning March 31, 2018, H&S Code 1596.8662 requires all directors and employees to complete mandated reporting training, and to renew the training every two years. All staff members present possesses current EMSA approved Pediatric CPR/First Aid certifications (expires 04/2027). Quarterly trainings with staff have occurred on12/20/2024 (Children’s Personal Rights, Child Care and Supervision) and on 04/17/2025 (First Aid and CPR).

A random sample of 4 children's records were reviewed. There was a separate, complete, and current record for 4 out of 4 children’s files. In the areas reviewed, the children’s files were found to be in full compliance. Sign in/out procedure was reviewed for compliance. Parents/Authorized Representative use the BrightWheel app for sign in/out, with QR codes posted at the 3 main entry points to the facility.

The licensee was informed that Licensing Quarterly Updates are available at www.ccld.ca.gov and may request to be added to an email list to receive a Quarterly Update from www.ccld.ca.gov and select Receive Important Updates link. LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

Based on LPA observation, interviews, and record review the following violation was observed and is being cited in accordance with California Code of Regulations, Title 22, Division 12, Chapter 3, Section 101238(a), is being cited on the attached LIC 809D.

Buildings and Grounds - Type B: 101238(a): The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Susan Deschampe
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2025
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 COSTA MESA
FACILITY NUMBER: 304370344
VISIT DATE: 07/30/2025
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Exit interview conducted and report was reviewed with the facility representative/director, Maria Teel. The Type B deficiency and Appeal Rights were discussed with facility representative, Maria Teel. The facility representative/director was provided a copy of the 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 consecutive days. The “Notice of Site Visit” must be posted on, or immediately adjacent to, the interior side of the main door to the facility. Failure to post will result in Civil Penalties of $100.00.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

End of Report
NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Susan Deschampe
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/30/2025 03:59 PM - It Cannot Be Edited


Created By: Susan Deschampe On 07/30/2025 at 03:03 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: INT'L CHRISTIAN MONTESSORI ACADEMY OF COSTA MESA
FACILITY NUMBER: 304370344

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/28/2025
Section Cited
CCR
101238(a)

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California Code of Regulations, Title 22, Section 101238(a) Buildings and Grounds The child care center shall be...safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.
This requirement is not met evidenced by:
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Facility made the fenced area inaccessible to children (during visit).
Facility to replace wooden fence.
Facility to fill in the floor with cement.
Teacher will be placed in front of the hazardous points of the fence.
Facility will send updates to LPA.
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Based on observation and interview, the wooden fence in the preschool play area has multiple holes from deterioration (approximately 6 inches from ground, 2-3 inches diameter), exposed rusted screws/nails and splintering wood (pictures taken), and broken cement (pictures taken).
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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.
Thuy Ho
NAME OF LICENSING PROGRAM MANAGER:
Susan Deschampe
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/30/2025


LIC809 (FAS) - (06/04)
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