304371580-12-28-2022-06-CC-MMAK-CMJRB9-20221228115223

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371580
Report Date: 12/28/2022
Date Signed: 12/28/2022 11:52:31 AM

Document Has Been Signed on 12/28/2022 11:52 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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	NOBIS MONTESSORI		FACILITY NUMBER:	304371580
ADMINISTRATOR:	FOSTER, SUSAN		FACILITY TYPE:	830
ADDRESS:	264 NORTH MAIN STREET		TELEPHONE:	(714) 997-8333
CITY:	ORANGE	STATE: CA	ZIP CODE:	92868
CAPACITY: 12	TOTAL ENROLLED CHILDREN: 12	CENSUS: 0	DATE:	12/28/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Director		TIME COMPLETED:	11:30 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	Page 1 of 5 Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek conducted an announced on site pre-licensing inspection at this childcare center for the purpose of opening an infant center. LPA met with director, Susan Foster and Regional Director, Ashley Neitzke who gave LPA a tour of the new Infant classroom on the premises. One Infant room (Room # 6) has been designated for Infant care ages 6 weeks to 18 months old. The applicant has requested to provide care and supervision for 12 infants and toddlers ages 6 weeks to 18 months old, Monday through Friday 7:00 AM. to 6.00 PM. 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. Parents sign in and out through the side gate. Parents enter the outdoor area which leads to infant/toddler room ( Room # 6). Upon arrival each child has an health evaluation along with hand washing before they participate in the activities. Isolation area is the corner of the director’s office, located at the entrance of the facility and there is a staff bathroom close to this area for the use of sick child temporarily until child is picked up. Continued on page 2

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2022

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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: NOBIS MONTESSORI	FACILITY NUMBER: 304371580
	VISIT DATE: 12/28/2022

NARRATIVE

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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.
Safe sleep posters / SIDS

The following was observed in the Infant room with attached napping room
· Age appropriate furniture and equipment’s
· Toys, tactile equipment's
· Room is well lighted with ventilation.
· Infant room has a napping area with 12 cribs which is separated from the activity area by Plexi glass fencing.
Changing table is placed at a arm's reach of the sink, there is one sink in the infant room.
Storage cubbies are arranged to store personal belongings
Napping area: There are adequate numbers of cribs and mats in the infant room for the infants and toddlers. .
Cribs: Have a mattress with tight fitting sheets.
One crib shall be used by one infant at a time only.
Flooring: Vinyl flooring with play pads and non-slip rugs in the area.
All Infant items will be provided by the parents : Diapers/ Wipes/ Lotions / formula and Mother's milk
There is a Refrigerator in the classroom to store the milk and other items.

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2022

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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: NOBIS MONTESSORI	FACILITY NUMBER: 304371580
	VISIT DATE: 12/28/2022

NARRATIVE

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LPA discussed the Safe sleep practice with director, Susan Foster and Regional Director, Ashley Neitzke. LPA discussed the LIC 9227 form for infants sleeping plan and logging every 15 minutes checking on infants and toddlers under 24 months.

NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials
· Always place infants on their backs for sleeping
· Use only a tight-fitting sheet on the crib or play yard mattress
· Do not hang any items from the crib or above the crib
· Keep all items, including blankets, out of the crib or play yard
· Pacifiers may be used as long as they do not have items attached to them
· Infants should not be swaddled or have any items covering them while sleeping
· The temperature of the room should be comfortable enough for an adult to wear a T-shirt and not be too hot or too cold.

LPA measured the assigned Infant Room (Room # 6)
Indoor activity space : 589 square feet divided by 35 = 16.82 ( 17 infants and Toddlers).
The facility has enough indoor space to meet the requested capacity for indoor space for 12 infants in infant Room (Room # 6).
The room measurement is after the deduction of the napping area which was 279 square feet.
Total sinks: 2 X 15= 30 children
1 X 15 toilets= 15 children
Outdoor activity space: 980 square feet divided by 75 = 13 infants and toddlers.

· Playground is fully enclosed by an appropriate fencing however, the infant/toddler yard was not fenced to be separated from preschool yard.

· Outdoor activity space is supplied with age and size appropriate equipment, outdoor activity toys.
Outdoor space surface is covered by natural grass and shade is provided by trees.
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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2022

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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: NOBIS MONTESSORI	FACILITY NUMBER: 304371580
	VISIT DATE: 12/28/2022

NARRATIVE

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Facility has sufficient space to accommodate the requested capacity of 12 Infants and toddlers in the designated Infant yard.

Fire clearance received from Orange County Fire Authority approving the requested capacity of 12 infants and toddlers in room # 6.

The director, Susan Foster is current on the required Immunization/ Pediatric CPR/ First training and has 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 : The director, Susan Foster and Regional Director, Ashley Neitzke were 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 the director, Susan Foster and Regional Director, Ashley Neitzke 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 director, Susan Foster and Regional Director, Ashley Neitzke 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.

Incidental Medical Services:
This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A
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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2022

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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: NOBIS MONTESSORI	FACILITY NUMBER: 304371580
	VISIT DATE: 12/28/2022

NARRATIVE

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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 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.

Facility needs to complete the following items before a final license can be issued:

(1) Installation of at least 4 feet high fencing on the outdoor space for the infants and toddlers to separated the two programs yards from each other.
A license for a total of 12 infants and toddlers ages 6 weeks to 18 months in Room # 6, Monday to Friday 7:00 am to 6:00 PM, will be issued upon receiving the above correction and Management approval.
Reports read and appeal rights presented to the director, Susan Foster and Regional Director, Ashley Neitzke
End of reports

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2022

LIC809 (FAS) - (06/04)

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