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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371173
Report Date: 10/06/2021
Date Signed: 10/06/2021 03:58:13 PM

Document Has Been Signed on 10/06/2021 03:58 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:CHAPMAN MONTESSORI SCHOOLFACILITY NUMBER:
304371173
ADMINISTRATOR:DAHANAYAKE, NILMINIFACILITY TYPE:
850
ADDRESS:11832 EUCLID AVETELEPHONE:
(714) 725-2681
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY: 48TOTAL ENROLLED CHILDREN: 0CENSUS: 24DATE:
10/06/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:12 PM
MET WITH:School director Nilmini DahanayakeTIME COMPLETED:
04:15 PM
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An unannounced case management-licensee initiated inspection was conducted on this date by Licensing Program Analyst (LPA) Tina Nguyen, in response to a request to convert the toddler option (18 mos.-36 mos.) classroom to preschool classroom. Currently this facility license for one preschool classroom room #10, one toddler option classroom Room #8, and waiver for one school age classroom room #9. By converting the toddler option classroom to preschool classroom, the total capacity requested for this facility is 36 preschool children (ages 2-6 years) and waiver for 12 school age children. LPA met with director Nilmini Dahanayake. Census was taken. There were two staffs supervising 9 toddler option children; 1 staff supervising 11 preschool children in room 10; 1 staff supervising 4 school age children. Per director, the facility operating hour is 6: 30 AM to 6:30 PM, Monday to Friday.

A review of staff or individuals who require caregiver background checks have received a criminal record clearances or exemptions and a child abuse index clearance.

Incidental Medical Service-IMS was discussed. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

Copies of child care provider's guide to safe sleep pamphlet and Never Ever Shake a Baby pamphlet with the website www.dontshake.org were given to the facility representative on the previous inspection. A copy of the Effect of Lead Exposure pamphlet was given to the provider. The facility representative was informed that they can refer to our Department website at www.ccld.ca.gov for obtaining the quarterly updates.
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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Tina Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2021
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: CHAPMAN MONTESSORI SCHOOL
FACILITY NUMBER: 304371173
VISIT DATE: 10/06/2021
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In the areas that were evaluated, the facility was in compliance of the California Code of Regulations, Title 22, Division 12.

This facility meets licensing requirements on this date and a license will be issued pending a final review.

Exit interview was conducted. 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 right (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.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Tina Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
LIC809 (FAS) - (06/04)
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