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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371464
Report Date: 03/12/2025
Date Signed: 03/13/2025 09:49:17 AM

Document Has Been Signed on 03/13/2025 09:49 AM - 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:SMILES MONTESSORI CHILDCAREFACILITY NUMBER:
304371464
ADMINISTRATOR/
DIRECTOR:		AHN, SUNG JAFACILITY TYPE:
850
ADDRESS:2261 NORTH ORANGE OLIVE ROADTELEPHONE:
(714) 283-2857
CITY:ORANGESTATE: CAZIP CODE:
92865
CAPACITY: 40TOTAL ENROLLED CHILDREN: 28CENSUS: 18DATE:
03/12/2025
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Licensee, Sung Ja "Annie" AhnTIME VISIT/
INSPECTION COMPLETED:
05:30 PM
NARRATIVE
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On 3/12/25, Licensing Program Analysts (LPAs), Christine Jung and Giselle Lucero, conducted an unannounced case management – legal/noncompliance inspection. Upon entry at 8:45AM, LPAs met with Director, Sung Ja Ahn, and was led on a tour of the facility. There were 18 preschool children and three (3) preschool staff members present. The facility was operating within teacher-child ratios and licensed capacity.
Facility Personnel Report Summary review indicated all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Korean translation was provided by LPA Jung during the visit.

Upon arrival, LPAs conducted record reviews for staff and children.

Staff 1 (S1) did not have a complete personnel record; see LIC 809D for deficiency. This is a repeated violation - civil penalty will be assessed; see LIC 421FC for civil penalty.

17 out of 17 children’s files were reviewed: 5 out of 17 children’s files had incomplete CDPH 286; Child 17 (C17) was missing their LIC 503, tuberculosis test, and had an incomplete immunization record; Child 14 (C14) and Child 12 (C12) were missing their LIC 702; Child 9 (C9) was missing their LIC 627, 995A, 613A; see LIC 809D for deficiency.

LPAs also observed 17 out of 17 children’s files reviewed had missing LIC 9224; see LIC 809D for deficiency.
Each staff file had a current Mandated Reporter Certificate. There was at least one staff present who had a current Pediatric First Aid/CPR certificate which expires 09/2025.

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SUPERVISORS NAME: Nguyen K Tran
LICENSING EVALUATOR NAME: Soo Jin Jung
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: SMILES MONTESSORI CHILDCARE
FACILITY NUMBER: 304371464
VISIT DATE: 03/12/2025
NARRATIVE
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(Page 2)
Facility did not conduct an emergency drill since 8/30/2024; see LIC 809D for deficiency. This is a repeated violation - civil penalty will be assessed; see LIC 421FC for civil penalty.

There were poisonous items stored in the kitchen cabinet without a lock; see LIC 809D for deficiency.

There was a broken tricycle in the play yard; see LIC 809D for deficiency. This is a repeated violation - civil penalty will be assessed; see LIC 421FC for civil penalty.

There were two (2) preschool children who were not signed in upon drop off; see LIC 809D deficiency.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee/Director, Sung Ja Ahn.

(End of Report)
SUPERVISORS NAME: Nguyen K Tran
LICENSING EVALUATOR NAME: Soo Jin Jung
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/13/2025 09:49 AM - It Cannot Be Edited


Created By: Soo Jin Jung On 03/12/2025 at 02:53 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: SMILES MONTESSORI CHILDCARE
FACILITY NUMBER: 304371464

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/21/2025
Section Cited
CCR
101174(d)

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101174(d) Disaster drills shall be conducted at least every six months. This requirement was not met as evidenced by:
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Licensee/Director stated that they will conduct an emergency drill and submit copy of the emergency drill log to LPA via email by due date.
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in that, facility did not complete an emergency disaster drill since 8/30/24, which poses a potential health, safety or personal rights risk to persons in care.
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Type B
03/12/2025
Section Cited
CCR101238(a)

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101238(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement was not met as evidenced by:
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Licensee/Director removed the broken tricycle during the visit.
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Based on observation, the licensee did not comply with the section cited above in that, there was a broken tricycle in the play yard, which poses a potential health, safety or personal rights risk to persons 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:Nguyen K Tran
LICENSING EVALUATOR NAME:Soo Jin Jung
LICENSING EVALUATOR SIGNATURE:
DATE: 03/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/12/2025


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Document Has Been Signed on 03/13/2025 09:49 AM - It Cannot Be Edited


Created By: Soo Jin Jung On 03/12/2025 at 03:14 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: SMILES MONTESSORI CHILDCARE
FACILITY NUMBER: 304371464

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/21/2025
Section Cited
CCR
101217(a)

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101217(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. This requirement was not met as evidenced by:
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Licensee/Director stated that they will submit a copy of completed personnel record for S1 to LPA via email by due date.
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Based on record review, the licensee did not comply with the section cited above in that, Staff 1 (S1) did not have a complete personnel record, which poses a potential health, safety or personal rights risk to persons in care.

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Type B
03/21/2025
Section Cited
CCR101229.1(b)

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101229.1(b) The person who brings the child to, and removes the child from, the center shall sign the child in/out. This requirement was not met as evidenced by:
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Licensee/Director stated that they will submit a copy of competed sign in sheet to LPA via email by due date.
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Based on record review, the licensee did not comply with the section cited above in that, 2 out of 18 children were not signed in, which poses a potential health, safety or personal rights risk to persons 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:Nguyen K Tran
LICENSING EVALUATOR NAME:Soo Jin Jung
LICENSING EVALUATOR SIGNATURE:
DATE: 03/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/12/2025


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Document Has Been Signed on 03/13/2025 09:49 AM - It Cannot Be Edited


Created By: Soo Jin Jung On 03/12/2025 at 03:19 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: SMILES MONTESSORI CHILDCARE
FACILITY NUMBER: 304371464

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/21/2025
Section Cited
CCR
101221(a)

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101221(a) A separate, complete and current record for each child is maintained in the child care center. This requirement was not met as evidenced by:
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Licensee/director stated they will submit copies of missing documents from children files to LPA via email by due date. List of missing documents were provided to licensee/director.
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in that, 17 out of 17 children files reviewed were incomplete, which poses a potential health, safety or personal rights risk to persons in care.
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Type B
03/21/2025
Section Cited
CCR101238(g)(1)

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101238 (g)(1) Storage areas for poisons shall be locked. This requirement was not met as evidenced by:
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Licensee stated they will move the poisons to a locked cabinet and send picture to LPA via email by due date.
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Based on observation, the licensee did not comply with the section cited above in that, poisons were not stored in a locked area, which poses a potential health, safety or personal rights risk to persons 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:Nguyen K Tran
LICENSING EVALUATOR NAME:Soo Jin Jung
LICENSING EVALUATOR SIGNATURE:
DATE: 03/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/12/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/13/2025 09:49 AM - It Cannot Be Edited


Created By: Soo Jin Jung On 03/12/2025 at 03:36 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: SMILES MONTESSORI CHILDCARE
FACILITY NUMBER: 304371464

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/21/2025
Section Cited
HSC
1596.8595(c)(1)

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1596.8595(c)(1) A licensed child day care facility shall provide to the parents or guardians of each child...copies of any licensing report that documents any Type A citation that represents an immediate risk... to children in care. This requirement is not met as evidenced by:
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Licensee/director stated that they will provide appropriate LIC 9224 and obtain Acknowledgement of Receipt and submit copies to LPA via email by due date. LPA provided list of missing LIC 9224 specific to each child.
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Based on record review, the licensee did not comply with the section cited above in that, 17 out of 17 children files did not have all required LIC 9224, which poses a potential health, safety or personal rights risk to persons 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:Nguyen K Tran
LICENSING EVALUATOR NAME:Soo Jin Jung
LICENSING EVALUATOR SIGNATURE:
DATE: 03/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/12/2025


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