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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371566
Report Date: 07/22/2022
Date Signed: 07/25/2022 06:47:22 PM


Document Has Been Signed on 07/25/2022 06:47 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:GIVINGTREE MONTESSORIFACILITY NUMBER:
304371566
ADMINISTRATOR:RHO, YUN HEEFACILITY TYPE:
850
ADDRESS:1911 NORTH EUCLID STREETTELEPHONE:
(714) 336-2872
CITY:FULLERTONSTATE: CAZIP CODE:
92835
CAPACITY:30CENSUS: 0DATE:
07/22/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Owner/ Applicant Ms. Seong Mi SonTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Ms. Ketki Desai conducted an announced on site pre-licensing inspection at the childcare center. It is a New center. LPA met with the Owner/ Applicant Ms. Seong Mi Son, along with an adult member of the home Ms. Jin- Joo, who gave a tour of the Child Care Center. The center has requested a Preschool program with Toddler option in the three assigned rooms along with one activity room and Library area, with a designated outdoor play-yard.

The applicant has requested to provide care and supervision for 40 Pre-school age children 2 to 5 years of age, along with 14 Toddler option children (18 months to 36 months ) in Toddler classroom . Monday through Friday 8:00 AM. to 6.00 PM. in the assigned classrooms.

LPA observed staff following CDC and Dept of Public Health Guidelines. Due to COVID Pandemic parents shall be encouraged to follow the CDC and COVID requirements.

A review of the Facility Personnel Report Summary on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The facility is on the premises of a business complex, there is sufficient parking in front of the facility entrance door, next to the Kumon Math classes . Manual sign in table has been set up at the entrance of the facility, where parents shall sign in and the children shall enter through the designated classroom door. Upon arrival each child has an health evaluation along with hand washing before they participate in the activities.

Isolation area is the Director’s office, located in front of the entrance door of the facility and there is an open lobby area, Director has an additional cot with linens for the sick child, the child shall use the restroom located at the end of the passage area . (1)
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:
DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2022
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: GIVINGTREE MONTESSORI
FACILITY NUMBER: 304371566
VISIT DATE: 07/22/2022
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LPA discussed the posting requirements including, but limited to, the following:
· Facility License in public area (101160)
· Emergency Disaster Plan (LIC 610)
· Earthquake Preparedness Check List (LIC 9148)
· Parents’ Rights Poster (PUB 393)
· Personal Rights (LIC 613A)
· Menus / Activity Schedule
· Notice of Site Visit (LIC 9213) and Type A deficiencies / Plan of Corrections of Type A deficiencies
· Granted Waivers (available for review)
· Child Car Seat Law (PUB 269) & · COVID Posters.

The following were inspected in the indoor activity space:
· Classroom are adequately equipped with age and size appropriate furniture and equipment
· Drinking water is available inside through personalized water bottles and water pitchers in each preschool rooms.
· Sign in/Sign out procedure was reviewed and meets regulation requirements (Manual sign in and out)
· Facility has built in smoke detector, carbon monoxide detector, additional carbon monoxide detectors are also installed in each rooms with fire extinguishers mounted in each classrooms that meet statutory requirements along with the Fire Alarm system recently installed and approved.
· 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, napping linens and blankets are provided by the parents, facility also has additional linens if needed.
· Facility has a kitchen area where daily meals shall be prepared and served to the children. Facility is enrolled in a food program with KFAM : Korean American Family Services. They will serve Breakfast at 9.00 am / Lunch at 11.40 am and Dinner at 4.00 PM. In-between snacks shall be served.
Rooms are well lighted with proper ventilation
Each room has age appropriate activity items and space to move around.
Toddler room also has age appropriate activities and educational items for the Toddlers.
There is Central Air and Heating system in the facility and air vents for proper air flow. A/C unit is not accessible to children and it is in the off limits area on the premises. (2)
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022
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: GIVINGTREE MONTESSORI
FACILITY NUMBER: 304371566
VISIT DATE: 07/22/2022
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LPA measured the two assigned Preschool rooms / Activityt room and Library area ( Activity room and Library area shall be used for activities by Preschool and Toddler children)
Indoor activity space for Preschool : 1200'40 divided by 35 = 34' 30 ( 34 children)
Facility does not have sufficient indoor activity space to accommodate the requested capacity of 40 preschool age children. It shall accommodate only 34 Preschool age children.

Total sinks : 5 X 15= 75 children / Total Toilets: 5 X 15= 75 children
(3 baby toilets assigned to Preschool/ 1 toilet for Toddlers and 1 Adult toilet on the premises)

Facility has age appropriate sinks and toilets in the classrooms.

Preschool outdoor play yard : Facility has designated Preschool yard and following was observed:


· Playground is fully enclosed by an appropriate fencing
· Drinking water is available outdoors by water pitchers and personal water 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: Soft tire chips
· Adequate shade is provided by shaded structure roof line and umbrella's
· There is also a sand box area and picnic area for the children
The play structure is safe for the age group to be served (2-6 years old)
Shaded lunch area has been set up for outdoor lunch activity.

Total outdoor activity space: 4360'79 divided by 75 = 58'14 ( 58 children)

Toddler option: Facility has also requested a Toddler option program with a capacity of 14. There is one room assigned to the Toddlers. The room was observed to be appropriate for Toddler option. There is age appropriate furniture/ activities and learning items for the Toddlers. Facility has age appropriate toilet and sink designated to the Toddlers along with potty chair. Toddlers shall share the yard on a rotating schedule with Preschool children.

Indoor Toddler room measurement = 230'55 divided by 35 = 6'59 ( 7 Toddlers)
Facility does not have sufficient space to accommodate 14 Toddlers as requested. (3)
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: GIVINGTREE MONTESSORI
FACILITY NUMBER: 304371566
VISIT DATE: 07/22/2022
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Based on the indoor measurements, sink and toilet availability, facility has sufficient space to accommodate only 34 Preschool age children (2-5 years old) in the assigned two classrooms, activity room and Library area, along with 7 Toddlers (18- 36 months) in one assigned room.
Facility has sufficient outdoor space with Sinks and Toilets for the age groups to be served. Facility shall request a waiver for Toddler option to share the Preschool yard on a rotating basis.

Fire clearance received from Fullerton Fire inspection Services have approved the initial requested capacity of 54 children in the three rooms. A revised fire inspection approval shall be obtained.

Applicant Ms. Seong Mi Son is current on the required Immunization/ Pediatric CPR/ First training valid through June 19th 2023, and have provided the completion certificate for the Preventive Health training (Nutrition and Lead component and Mandated Child abuse reporting training.

Following items were discussed at the time of Exit interview.
Criminal Record Statement : Applicant, Seong Mi Son was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Safe Sleep : LPA discussed the safe sleep regulations with applicant Ms. Seong Mi Son discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant, Ms. Seong Mi Son of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

(4)

SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: GIVINGTREE MONTESSORI
FACILITY NUMBER: 304371566
VISIT DATE: 07/22/2022
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Incidental Medical Services (IMS): This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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

Review of records to be maintained

Child Care Centers :LPA reviewed with applicant, the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

Subscribe to CCLD important information

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important license-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

A license for 34 Preschool age children (2-5 years) in Preschool Room # 1 and Preschool # 2 .


7 Toddler option children in Toddler room # 3. Activity room and Library area are designated as additional Activity rooms. Total Capacity = 41 children . Monday to Friday 8.00 am to 6.00 PM, shall be issued upon management approval.
Facility shall request a Waiver for Toddlers sharing the yard with the Preschool children.

Report read and appeal rights presented to the applicant Ms. Seong Mi Son.
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022
LIC809 (FAS) - (06/04)
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