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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371039
Report Date: 04/28/2023
Date Signed: 04/28/2023 12:00:59 PM

Document Has Been Signed on 04/28/2023 12:00 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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:BELLA MONTESSORIFACILITY NUMBER:
304371039
ADMINISTRATOR:EVANGELISTA, STEFANIEANFACILITY TYPE:
850
ADDRESS:20602 PRISM PLACETELEPHONE:
(949) 900-2420
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY: 150TOTAL ENROLLED CHILDREN: 150CENSUS: 17DATE:
04/28/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
07:50 AM
MET WITH:Stefanie EvangelistaTIME COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Thompson arrived at the facility to conduct an unannounced complaint investigation on today’s date. Upon arrival LPA met with Lead Teacher Simina Osmani. LPA and Lead Teacher toured the facility and LPA observed 17 preschool age children along with 4 staff. LPA then met with Director Stefanie Evangelista when she arrived at 8:15 AM.

A review of the Facility Personnel Report Summary on this date indicates all staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios.

While touring the indoor activity space at 8:01 AM, LPA observed 10 children, ages 4-5 years old and one (1) staff inside the Meadow classroom. LPA observed approximately 50 nails placed on the cabinet, near the sink which was accessible to children in care.

In the areas that were evaluated, one type A 101238 Buildings and Grounds deficiency was observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit. Please see LIC 809D to review the citation page.



LPA Thompson informed Director Stefanie Evangelista that this report dated 4/28/2023 document(s) one Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

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SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Dean Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/28/2023
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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: BELLA MONTESSORI
FACILITY NUMBER: 304371039
VISIT DATE: 04/28/2023
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Also, LPA Thompson informed the Director Stefanie Evangelista to provide a copy of this licensing report dated 4/28/2023 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with Director Stefanie Evangelista. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.



Appeal Rights and deficiency were explained. Director Stefanie Evangelista was provided a copy of 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 Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above.
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Dean Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/28/2023 12:00 PM - It Cannot Be Edited


Created By: Dean Thompson On 04/28/2023 at 08:50 AM
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: BELLA MONTESSORI
FACILITY NUMBER: 304371039

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/28/2023
Section Cited
CCR
101238(g)

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101238 Buildings and Grounds (g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. This requirement is not met as evidence by:
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LPA observed the teacher inside Meadow classroom remove the nails and placed them in a storage cabinet above the counter at the time of visit.
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While touring the indoor activity space at 8:01 AM, LPA observed 10 children, ages 4-5 years old and one (1) staff inside the Meadow classroom. LPA observed approximately 50 nails placed on the cabinet, near the sink which was accessible to children in care.
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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.
SUPERVISOR'S NAME:Judy Hanson
LICENSING EVALUATOR NAME:Dean Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 04/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/28/2023


LIC809 (FAS) - (06/04)
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