304371566-9-25-2024-06-CC-AFCN-D9FPHJ-20240925112001

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371566
Report Date: 09/25/2024
Date Signed: 09/25/2024 11:20:18 AM

Document Has Been Signed on 09/25/2024 11:20 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:	GIVINGTREE MONTESSORI		FACILITY NUMBER:	304371566
ADMINISTRATOR/ DIRECTOR:	RHO, YUN HEE		FACILITY TYPE:	850
ADDRESS:	1911 NORTH EUCLID STREET		TELEPHONE:	(714) 336-2872
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92835
CAPACITY: 41	TOTAL ENROLLED CHILDREN: 41	CENSUS: 33	DATE:	09/25/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Owner Seongmi Son		TIME VISIT/ INSPECTION COMPLETED:	11:50 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 09/25/2024 at 9am, Licensing Program Analyst (LPA), Anna Chan conducted an onsite inspection for the purpose of an unannounced Annual Inspection. LPA met with Owner Seongmi Son and Director Youngae Kim. LPA and director toured the facility inside and outside and the floor and yard plan (LIC 999) were verified. Census was taken in individual classrooms. The overall census observed 33 children including 12 toddlers, and 4 staff including 2 toddler staff. Children were having indoor activities when LPA arrived. Owner continued with the visit. Office staff Jeanie Yu stepped in as interpreter for Seongmi Son. Owner prefers Korean Speaking Analyst in future licensing inspection. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. Facility hours are 8:00 a.m.- 6:00p.m., Monday through Friday. A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. During the inspection of the indoor activity space, items which could pose a danger to children (detergents, cleaning compounds, and medications) were observed to be stored out of the reach of children. Poisons/Hazardous Items are not kept on the premises. The facility provides meal to children. Menus are posted where it can be seen by parents at the board near the entrance door of the facility. Food prep areas were clean and sanitary. Food is properly stored. Floors, equipment, and furniture were clean and were observed to be in good repair and free of sharp edges. There is drinking water available to children indoors by filtered water and sports bottles with the child’s name on it. Beddings are stored individually. Beddings are brought home for washing weekly. The facility has conducted an emergency drill within the past six months on 4/19/2024. Page 1 of 4

SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024

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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Document Has Been Signed on 09/25/2024 11:20 AM - It Cannot Be Edited

Created By: Anna Francesca Chan On 09/25/2024 at 10:41 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: GIVINGTREE MONTESSORI	FACILITY NUMBER: 304371566
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/25/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101429(a)(2)(C)

Responsibility for Providing Care and Supervision for Infants

(C) Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above 2 toddler files does not have 15-minute sleep log, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/25/2024
	Plan of Correction
1 2 3 4	Licensee/Owner stated the facility will start recording 15 minute sleep log and will provide LPA a proof of the record by email by due date 10/25/24

Type B

Section Cited

CCR

101221(a)

Child's Records

(a) The licensee shall ensure that a separate, complete and current record for each child is maintained in the child care center. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 1 of 5 chilren were missing personal rights, parent's rights and consent for emergency medical treatment which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/25/2024
	Plan of Correction
1 2 3 4	Licensee stated they will have the parents sign the missing forms and will provide LPA a copy by due date 10/25/24

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:

Martha Malane

LICENSING EVALUATOR NAME:

Anna Francesca Chan

LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024

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: GIVINGTREE MONTESSORI	FACILITY NUMBER: 304371566
	VISIT DATE: 09/25/2024

NARRATIVE

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The facility has a working carbon monoxide detector and fire extinguisher. Facility met all posting requirement. The California Child Passenger Safety Law was posted by the entrance of the facility

The outdoor activity space was inspected for compliance. The playground was enclosed by a fence at least four feet in height.The surface of the outdoor activity space was well maintained and free of hazards. The cushioning material used is turf grass around the climbing equipment, and appeared to be enough to absorbs falls. There is drinking water available to children outdoors by filtered water and sports bottles with the child’s name on it. The outdoor equipment and toys were in good repair and free of sharp edges. Toddlers have their own playground with turf grass cushioning. There are no bodies of water present at the facility. The facility grounds were safe, sanitary and in good repair.

4 Staff files were reviewed for staff present during the facility inspection on this date. Health screening and immunizations as required were reviewed. Beginning September 1, 2016, Health and Safety (H&S)§1596.7995. (a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. Proof of immunization against pertussis, measles, and influenza (or written declaration of such) were reviewed and within compliance.

Beginning March 31, 2018, H&S Code 1596.8662 requires all directors and employees to complete mandated reporting training, and to renew the training every two years. 1 of 5 staff does not have a current Mandated Reporter training certificate. Certificate of Staff 1 expired January 2024. At least one staff member present possesses current EMSA approved Pediatric CPR/First Aid certifications, which expires 03/2026.

Owner was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
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SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024

LIC809 (FAS) - (06/04)

Page: 3 of 5

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: GIVINGTREE MONTESSORI	FACILITY NUMBER: 304371566
	VISIT DATE: 09/25/2024

NARRATIVE

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7 Children's records were reviewed, 1 of 7 children’s record with incomplete. In the areas reviewed the children’s files were not in compliance. 2 Toddler files 24 months and below are missing 15minute sleep log. Based on interview with Licensee, the facility does not log sleep check but there is always 2 staff supervising children during nap. Sign in and out were reviewed for compliance.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.

The Owner Seongmi Son was informed that Licensing Quarterly Updates are available at www.ccld.ca.gov (facility representative) may request to be added to an email list to receive a Quarterly Update by contacting the Child Care Advocate at childcareadvocatesprogram@dss.ca.gov or at www.ccld.ca.gov
LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

LPA discussed the safe sleep regulations with owner Seongmi Son and 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 licensee [facility representative] 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.

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SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024

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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: GIVINGTREE MONTESSORI	FACILITY NUMBER: 304371566
	VISIT DATE: 09/25/2024

NARRATIVE

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Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. LPA verified that the lead testing was completed in 9/10/22, in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

The facility conducted Lead Testing on 12/30/22 and no lead exceedance.

In the areas that were evaluated, the following 2 Type B violations were observed and are being cited in accordance with California Code of Regulations Title 22, Division 12 Section 101221(a) Child’s Records and 101429(a)(2)(C) Responsibility for Providing Care and Supervision for Infants

Exit interview conducted and report was reviewed with the Owner Seongmi Son. Appeal Rights and deficiencies were discussed. The licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days.

Owner was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. The “Notice of Site Visit” must be posted on or adjacent to the door. Failure to post will result in Civil Penalties of $100.00.

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SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024

LIC809 (FAS) - (06/04)

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