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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371465
Report Date: 05/08/2026
Date Signed: 05/08/2026 12:42:31 PM

Document Has Been Signed on 05/08/2026 12:42 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:SMILES MONTESSORI CHILDCAREFACILITY NUMBER:
304371465
ADMINISTRATOR/
DIRECTOR:		AHN, SUNG JAFACILITY TYPE:
830
ADDRESS:2261 NORTH ORANGE OLIVE ROADTELEPHONE:
(714) 283-2857
CITY:ORANGESTATE: CAZIP CODE:
92865
CAPACITY: 20TOTAL ENROLLED CHILDREN: 2CENSUS: 2DATE:
05/08/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Facility representative, Sung Ja AhnTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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On 5/8/2026 at 11am, Licensing Program Analyst (LPA) Sarah Garcia conducted an unannounced Case Management inspection at the above childcare center. Upon arrival, LPA met with facility representative, Sung Ja Ahn. Director guided LPA on a walkthrough of the facility and took a census. Total census was 2 children and 2 staff. LPA Soo Jin Jung assisted with Korean translation interpretation via telephone.

A review of staff records on this date indicated that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During the visit at the facility on 04/29/2026, In accordance to The Stipulation and Waiver and Order (CDSS No. 624284101, 6624284101B, and 6624284101C), LPA discovered the facility did not follow Stipulation and Waiver and Order section 4. Term of Probation H. Respondent, Sung Ja Ahn, shall not hold a managerial position, supervisor and/or director position and shall not be involved in any duties subscribed to a Licensee, Administrator and/or Director related to any facility licensed by the Department of Social Services and (J) Respondent, Sung Ja Ahn, shall provide care and supervision to clients in care at the facility only under the supervision of the licensee or another staff member.

During today's visit, LPA interviewed 1 staff. LPA utilized Korean translation interpreter ID#498440.

During the investigation, LPA Garcia interviewed 3 staff, authorized representatives, and reviewed the facility roster and April incidents.


(continue to page 2)

NAME OF LICENSING PROGRAM MANAGER: Tina Nguyen
NAME OF LICENSING PROGRAM ANALYST: Sarah Garcia
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/08/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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: SMILES MONTESSORI CHILDCARE
FACILITY NUMBER: 304371465
VISIT DATE: 05/08/2026
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(Page 2)

During staff interviews on 4/28/2026, Staff 2 (S2) stated on 4/13/26 they were watching Child 1 (C1) by themselves at approximately 7am in the preschool yard and as C1 grabbed the bicycle handle, it went sideways and C1 fell and bumped head.

During inspections on 4/28/2026 and 5/8/2026, S2 presented themselves as the center director. LPM Nguyen also conducted an interview with Staff 4 (S4) and confirmed that S2 is the center director.

LPA interviewed authorized representatives. Representatives interviewed disclosed that on 2/3/2026 at approximately 5pm, they observed S2 supervising children by themselves.

Based on observations, interviews and record review, it has been determined the facility did not follow the Stipulation and Waiver; and Order (CDSS No. 624284101, 6624284101B, and 6624284101C) Section (4)(H) & (J). The following violation of Health and Safety Code 1596.885 Denial, suspension or revocation of license, registration, or special permits; grounds is being cited on the attached LIC 9099D. LPA provided facility representative with the Health and Safety Code Section 1596.885 for reference. Civil penalty was issued for repeated citation. Facility was cited for the same deficiency on 02/03/2026.

Exit interview conducted and report was reviewed with the facility representative, Sung Ja Ahn. A notice of site visit was given and must remain posted for 30 days.

End of Report.

NAME OF LICENSING PROGRAM MANAGER: Tina Nguyen
NAME OF LICENSING PROGRAM ANALYST: Sarah Garcia
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2026
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 05/08/2026 12:42 PM - It Cannot Be Edited


Created By: Sarah Garcia On 05/08/2026 at 10:09 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: SMILES MONTESSORI CHILDCARE
FACILITY NUMBER: 304371465

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/08/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/11/2026
Section Cited
HSC
1596.885

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HSC 1596.885 Denial, suspension or revocation of license, registration, or special permits; grounds - The department may deny an application for or suspend or revoke… under this act upon any of the following… Conduct which is inimical to the health, morals, welfare, or safety of either an individual... from the facility.... This requirement was not met as evidenced by:
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Facility representative will submit a declaration stating they understand the Stipulation which states they cannot be center director or alone supervising children to LPA via email by 5pm on 5/11/2026.
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Based on observation, interview, and file review, the facility did not comply with the section cited above, in violation of Stipulation and Waiver; and Order (CDSS No. 624284101, 6624284101B, and 6624284101C) Section (4)(J) as S1 was alone and providing care to C1 and on 4/28/2026 and 5/8/2026, S2 presented themselves as the center director which poses an immediate 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.
Tina Nguyen
NAME OF LICENSING PROGRAM MANAGER:
Sarah Garcia
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/08/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/08/2026


LIC809 (FAS) - (06/04)
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