304371438-11-18-2021-06-CC-KDEI-C8VVK8-20211118152955

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371438
Report Date: 11/18/2021
Date Signed: 11/18/2021 03:30:02 PM

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:	GAOWA MONTESSORI SCHOOL		FACILITY NUMBER:	304371438
ADMINISTRATOR:	AMANDA MARIE TAYLOR		FACILITY TYPE:	850
ADDRESS:	1620 ADAMS AVENUE		TELEPHONE:	(714) 714-0055
CITY:	COSTA MESA	STATE: CA	ZIP CODE:	92626
CAPACITY:	120	CENSUS:	DATE:	11/18/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	01:05 PM
MET WITH:	Licensee Mr. Moreno,Alejandro		TIME COMPLETED:	03:45 PM

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Licensing Program Analyst (LPA) Desai, Ketki conducted an unannounced Case Management Licensee initiated inspection for adding a room for Toddler component while decreasing the Preschool capacity.

Facility is currently licensed for 120 children. (96 preschool children ages (2.5 years to 6 years old) in the six rooms and 24 toddlers in two assigned rooms.

Facility is now seeking to add one additional Toddler room with an increase in capacity to 36 toddlers and decreasing the Preschool capacity to 84 preschool age children.

Facility shall remove Preschool Room # 5 (Saturn room) but shall continue to use Room # 1(Venus) Room # 2 (Pluto), Room # 3 (Neptune), Room # 4 (Mars), Room # 8 (Earth) for the requested 84 preschool age children including the three Piano rooms.

LPA met with Facility Licensee Mr. Moreno, Alejandro who gave a tour of the facility including the new toddler room.

The following were inspected in the indoor activity space: New Toddler room

· Classrooms are adequately equipped with age and size appropriate furniture and equipment
· Drinking water is available through water fountains in the hallway, water pitchers inside the classroom as well as individual sports bottles if they prefer
· Sign in/Sign out procedure was reviewed and meets regulation requirements (Electronic sign in and out)
· There is a working smoke detector, Fire Sprinkler system and fire extinguisher that meet statutory requirements. Being new construction, there is no natural Gas supply, hence Carbon Monoxide detectors are not required. Fire department has given the required approval.
· Cubbies available for storage of individual child’s personal belongings and/or bedding
· Napping equipment: Cots are used and are stored in the corner of each room on a rolling cart. Napping linens are brought from home (Page-1)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021

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: GAOWA MONTESSORI SCHOOL	FACILITY NUMBER: 304371438
	VISIT DATE: 11/18/2021

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· Facility shall provide two snacks through the day, while lunch shall be brought from home and stored in their individual bags in their cubbies.
* There is a designated toilet with three toilets, one urinal, three sinks and a changing table in the Toddler bathroom across the toddler rooms and additional potty chairs are also available if needed.
* Each Toddler room has one sink inside the classroom.

Indoor Measurements for three Toddler rooms
Room # 5 (Saturn): 19’33” X 22’67” =438’21
Room # 6 (Mercury): 21’92” X 19’42” = 425’69
Room # 7 (Jupiter): 37’17” x 19’42” = 721’84

Total Indoor capacity: 1,585’74 divided by 35 = 45.30 (45 (Toddlers): Capacity requested is 36.

Toilets and sinks (Toddler bathroom)
Sinks: 6 x 15 = 90 and Toilets: 3 x 15= 45 + 1 urinal

Preschool indoor measurements

Room Venus: 44’33” X 22’08” = 978’81”
Room Pluto: 34’50” X 12’92” = 445’74”
Room Neptune: 19’42” X 21’92” = 425’69”
Room Mars: 36’ X 22’67 = 816’12”
Room Earth: 65’42”X29’42” =1924’66
Piano Room # 1: 10’5” x 7’17” =75’29”
Piano Room # 2: 10’5” x 6’83” = 71’72”
Piano Room # 3: 10’5” X 7’17” = 75’29”

Total indoor space: 5,961’73 divided by 35 = 170 (Children)

Preschool Toilets and sinks
Sinks: 12 X 15 = 180 / Toilets: 9 X 12 = 108 (Page-2)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: GAOWA MONTESSORI SCHOOL	FACILITY NUMBER: 304371438
	VISIT DATE: 11/18/2021

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Outdoor play yard: Facility has two designated yards. (Sand box/ three climbing structures/ walking trail / side planter yard) Climbing structures are age appropriate for Toddlers as well as Preschool age children.
The following were inspected in the outdoor activity space;
· Playground is fully enclosed by an appropriate fencing
· Drinking water is available outdoors by water fountains, individual sports bottles
· Outdoor activity space is supplied with age and size appropriate equipment, including climbing play structures and outdoor activity toys
· An adequate amount of cushioning material consisting of form is in place under the play structures
· Adequate shade is provided by shaded canopy, sails and patio area.

Front yard: 110 X 76 = 8360
Side planter yard: 103 x 15’83” = 1630.49

Total Outdoor space: 9990.49 divided by 75 = 133.21

Facility shall submit a Waiver for a Shared yard on a rotating schedule between Preschool children and the Toddlers.

Based on Indoor / Outdoor measurements / Sink and Toilet availability, facility has enough space to accommodate the requested capacity of 36 toddlers (18 – 36 months) in Room Saturn/ Mercury and Jupiter and 84 Preschool age children, in the assigned rooms (Venus/ Pluto/ Neptune/ Mars / Earth and Three Piano Rooms) Monday to Friday 7:00AM to 6:00 PM. (Total capacity = 120 children)

Fire clearance has been received from City of Costa Mesa Fire Prevention office approving the requested capacity.

License with the new change in capacity shall be granted after the final review.

Exit interview conducted with the Facility Licensee, Appeal Rights were presented and Notice of Site visit was posted. (End of report)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021

LIC809 (FAS) - (06/04)

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