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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370750
Report Date: 06/17/2025
Date Signed: 06/17/2025 03:02:20 PM

Document Has Been Signed on 06/17/2025 03:02 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:DOVE CANYON MONTESSORI SCHOOLFACILITY NUMBER:
304370750
ADMINISTRATOR/
DIRECTOR:		ZADEH, ATOSAFACILITY TYPE:
850
ADDRESS:31971 DOVE CANYON DRIVETELEPHONE:
(949) 589-4501
CITY:TRABUCO CANYONSTATE: CAZIP CODE:
92679
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 26DATE:
06/17/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Director, Atosa ZadehTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Dianna Valdez Santana conducted a case management visit related to a complaint received by the Orange Regional Office on 3/24/2025 for the infant license.

LPA and Director, Atosa Zadeh toured the facility, and a cenus was taken, in the preschool license the census is as follows: Room #1 (younger Preschool) had 11 children and 1 staff, Room #2 (Older Preschool) had 10 children and 1 staff and the room #3 (Toddler class) had 5 toddlers and 1 staff. A review of staff criminal clearance 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 or exemptions.

During LPA’s initial visit to the facility on 4/2/2025 to open the investigation for the infant license, LPA observed a preschool staff with the following. LPA Valdez Santana arrived at the facility at approximately 9:30am and arrived to the facility’s front gate at approximately 9:36am. LPA rung the bell twice and minutes later a staff exited the building with a child in hand. LPA stated the purpose of the visit was and the staff said, "I will go get the Director". LPA stated the staff needed to allow LPA in and then staff stretched one arm to open gate for LPA and the other to keep the double doors to the building open and then said, "my class is alone". LPA did not know the staff had walked out of the staff member’s class and left the children alone. The staff walked approximately 40-45 feet to the front gate for about 1-2 minutes. LPA and staff member walked through the main hallway, the staff member’s classroom was at the end of the hallway (it is open, with a half partition) and there were 10 children. Then the Director came out of a classroom at approximately 9:40 am, LPA introduced herself and asked for the Director.
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NAME OF LICENSING PROGRAM MANAGER: Martha Malane
NAME OF LICENSING PROGRAM ANALYST: Dianna ValdezSantana
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2025
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: DOVE CANYON MONTESSORI SCHOOL
FACILITY NUMBER: 304370750
VISIT DATE: 06/17/2025
NARRATIVE
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 Director confirmed who she was and walked back to the classroom. LPA followed the Director into the classroom (full enclosed classroom) and there were about 9 children. She left the children alone for about 40 seconds-1 minute. Director stated that was the Director’s classroom and has always had a classroom.

Based on LPA's interviews and observations, the following violation was observed is being cited in accordance with California Code of Regulations, Title 22, Division 12, Section 101229(a)(1), is being cited one Type B on the attached LIC 809D.

Exit interview was conducted with Director/owner, Atosa Zadeh. The Notice of Site Visit was posted. Facility representative was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. The Licensee was provided a copy of their appeal rights (LIC 9058 01/16) 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.

Page 2 of 2. End of Report.

NAME OF LICENSING PROGRAM MANAGER: Martha Malane
NAME OF LICENSING PROGRAM ANALYST: Dianna ValdezSantana
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/17/2025 03:02 PM - It Cannot Be Edited


Created By: Dianna ValdezSantana On 06/17/2025 at 01:21 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: DOVE CANYON MONTESSORI SCHOOL
FACILITY NUMBER: 304370750

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/17/2025
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision: (a)The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time...This requirement is not met as evidenced by:
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Director stated she told the last LPAthat was at the facility was told the code, LPA Valdez Santana did not see any code on file. Director stated if/when her code changes she will notify the Department. Director told the staff when it's necessary staff will gather the children and have them wait at the door and
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S1 walked about 40-45 feet out the classroom for approximately 1-2 minutes leaving children alone. S2 walked of a classroom leaving children alone for about 40 seconds-1 minute. This poses a potential health, safety or personal rights risk to persons in care.
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not leave them alone.

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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.
Martha Malane
NAME OF LICENSING PROGRAM MANAGER:
Dianna ValdezSantana
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/17/2025


LIC809 (FAS) - (06/04)
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