304370750-9-12-2022-06-CC-MMAK-CJ7QPA-20220912122026

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304370750
Report Date: 09/12/2022
Date Signed: 09/12/2022 12:20:31 PM

Document Has Been Signed on 09/12/2022 12:20 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	DOVE CANYON MONTESSORI SCHOOL		FACILITY NUMBER:	304370750
ADMINISTRATOR:	ZADEH, ATOSA		FACILITY TYPE:	850
ADDRESS:	31971 DOVE CANYON DRIVE		TELEPHONE:	(949) 589-4501
CITY:	TRABUCO CANYON	STATE: CA	ZIP CODE:	92679
CAPACITY: 72	TOTAL ENROLLED CHILDREN: 72	CENSUS: 20	DATE:	09/12/2022
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Licensee/Director		TIME COMPLETED:	01:00 PM

NARRATIVE

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Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek conducted an announced Case Management inspection for the purpose of technical assistance to the licensee for filling out the application correctly by adding 6 toddlers from Toddler Option Program to her existing 12 toddlers in the same classroom without changing the total capacity of 72 children on the preschool license. Our office has received few incorrect applications (LIC 200A) regarding this matter. LPA needs to find out what exactly the director is requesting in order for her to submit an updated correct application (LIC 200A) to our office.

LPA met with licensee/director, Atosa Zadeh. The Covid-19 Emergency Response questionnaire was reviewed and answered. Due to COVID 19 guidelines, LPA observed the facility was following CDC and Dept of Public Health Guidelines. Census was taken. There were a total of 20 children present today. There were 9 preschool children with one staff in preschool room and 11 toddlers from Toddler Option Program with 2 staff in Toddler Room. Additional staff was at morning break.

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. Licensee was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

The facility is currently licensed for a capacity of 72 children including 12 toddlers from Toddler Option Program and an approved school age waiver for 12 school age children. According to director, there is no school age enrolled for this year. LPA measured the indoor and outdoor spaces.

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SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022

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: DOVE CANYON MONTESSORI SCHOOL	FACILITY NUMBER: 304370750
	VISIT DATE: 09/12/2022

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The inside activity area was measured and the findings are as follows: 1971 square feet divided by 35 = 56.31 (56 children) for the large preschool classroom including the school age waiver which meets the requested capacity of 42 preschool children and 12 school age children (waiver)

Toddler Option Room:

614 square feet divided by 35 = 17.58 (accommodates 18 toddler children)

The outside activity area was measured and the findings are as follows:
Preschool playground: 8419.919 square feet divided by 75 = 112 children.
Toddler playground: 792 square feet divided by 75 = 10.56 (accommodates 11 toddlers at any given time).

Bathrooms: children's bathrooms consist of
Total toilets 8 X 15 = 120 children
Total urinals 2 X 5 = 10 children
Total sinks 10 X 15 = 120 children
Toddler Option Room 2 toilets and 2 sinks in the classroom which is included in the total above number.
School age (waiver) has one toilet and one sink for each gender with a sign posted which is included in the total above number.

Facility has sufficient sinks and toilets to support the requested capacity of 72 children including 12 school age (waiver), 18 toddlers in Toddler Room, and 42 preschool age children in the large preschool room.

Notice of Site Visit : A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit Interview : Exit interview conducted and report was reviewed with the licensee/director, Atosa Zadeh. LPA reviewed the application (LIC 200A) and sketch of the facility (LIC 999) with the director in order a corrected application can be submitted. LPA advised the director all the annual fees and outstanding balances shall be cleared before doing any changes.

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SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022

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: DOVE CANYON MONTESSORI SCHOOL	FACILITY NUMBER: 304370750
	VISIT DATE: 09/12/2022

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The following documents/corrections need to be made in order to process the application for adding additional 6 toddlers from Toddler Option Program.

1- Corrected LIC 200 A

2- LIC 999

3- Fire clearance approval for approving additional toddlers.

4- All the annual fees and any outstanding fees shall be paid in order the changes happen.

5- Waiver request for toddlers to share the playground with no more than 11 toddlers at any give time.

For waiver request the following are needed:

1- Waiver request to share the playground on a rotating basis with no more than 11 toddler at any given time.

2- Sketch of indoor and outdoor space.

3- Schedule to Toddlers to share the playground on a rotating schedule in details.

3- Pictures of the playground.

4- LIC 500

The director was advised the group of toddlers from Toddler Option Program is maximum 12 toddlers with 2 teachers. The director shall arrange the room so two groups can be accommodated with no more than 12 toddlers in each group.

Based on the measurements of indoor and outdoor space with sinks and toilets: Facility has sufficient space to accommodate total capacity of 72 children including 12 school age children with waiver, 18 toddlers in Toddler Option Room, and 42 preschool children in Preschool large room and Toddler Option Room after receiving the above items.

The licensee will be notified if any additional information is required.

End of report.

SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022

LIC809 (FAS) - (06/04)

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