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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371465
Report Date: 03/12/2025
Date Signed: 03/13/2025 09:52:34 AM

Document Has Been Signed on 03/13/2025 09:52 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:
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: 14CENSUS: 8DATE:
03/12/2025
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Licensee, Sung Ja 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 eight (8) infant children and two (2) infant 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.

LPAs conducted record reviews for staff and children.

3 staff files were reviewed and found to be incomplete; see LIC 809D for deficiency. Staff 1 (S1) was missing their measles, mumps, and rubella vaccine and LIC 9108, LIC 9052, last page of LIC 501; Staff 2 (S2) was missing their pertussis vaccine, LIC 503, needs updated transcript, incomplete, and influenza; Staff 3 (S3) needs an updated education transcript, completed LIC 501, LIC 9052, and LIC 9108.

10 out of 10 children files were reviewed and found to be incomplete; see LIC 809D for deficiency. 3 out of 10 children files were missing their Infant Needs and Services Plan; 10 out of 10 children children files were missing CDPH 286; 8 out of 10 children files were missing LIC 9227; Child 2 (C2) was missing their LIC 700; Child 7 (C7) and Child 8 (C8) were missing their Admission Agreement; Child 9 (C9) was missing their Physician’s Report, LIC 627, and 995.

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.

(Go to Page 2)
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.

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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: SMILES MONTESSORI CHILDCARE
FACILITY NUMBER: 304371465
VISIT DATE: 03/12/2025
NARRATIVE
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(Page 2)
Facility did not have a current Emergency Disaster Plan LIC 610; see LIC 809D for 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)
Page: 2 of 5
Document Has Been Signed on 03/13/2025 09:52 AM - It Cannot Be Edited


Created By: Soo Jin Jung On 03/12/2025 at 04:03 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: 304371465

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 they would complete all missing documents from staff files and send copies to LPA via email by due date. List of missing documents were provided to licensee/director.
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Based on record review, the licensee did not comply with the section cited above in that, 3 out of 3 staff files reviewed were incomplete, which poses a potential health, safety or personal rights risk to persons in care.
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Type B
03/12/2025
Section Cited
CCR101174(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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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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Page: 3 of 5
Document Has Been Signed on 03/13/2025 09:52 AM - It Cannot Be Edited


Created By: Soo Jin Jung On 03/12/2025 at 04:07 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: 304371465

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, 10 out of 10 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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Type B
03/21/2025
Section Cited
CCR101221(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 is not met as evidenced by:
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Licensee/director stated that they will provide copies of missing documents from children's files to LPA via email by due date. LPA provided list of missing documents for each child to licensee/director.
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Based on record review, the licensee did not comply with the section cited above in that, 10 out of 10 children files has missing documents, 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)
Page: 4 of 5
Document Has Been Signed on 03/13/2025 09:52 AM - It Cannot Be Edited


Created By: Soo Jin Jung On 03/12/2025 at 05:01 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: 304371465

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
101429(a)(2)(B)

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101429(a)(2)(B) Staff shall physically check on sleeping infant(s) every 15 minutes and document the following. This requirement was not met as evidenced by:
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Licensee/director stated they will complete the 15 minute sleep log for infants 13-24 months and submit copies 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, infants 13-24 months did not have 15 minute sleep log for today, 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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