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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371681
Report Date: 06/23/2026
Date Signed: 06/23/2026 01:21:35 PM

Document Has Been Signed on 06/23/2026 01:21 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:CAPSTONE MONTESSORI SCHOOLFACILITY NUMBER:
304371681
ADMINISTRATOR/
DIRECTOR:		ZHANG, MINGXINFACILITY TYPE:
860
ADDRESS:2021 CALLE FRONTERATELEPHONE:
(949) 503-1199
CITY:SAN CLEMENTESTATE: CAZIP CODE:
92673
CAPACITY: 132TOTAL ENROLLED CHILDREN: 132CENSUS: 35DATE:
06/23/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Director, Angela BrionesTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Kathy Trinh conducted an unannounced case management incident inspection in response to a self-report Unusual Incident Report dated 06/11/2026. Upon arrival, LPA met with Director, Angela Briones. LPA observed 35 children with 13 staff. A review of staff criminal clearance records 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.

On 06/15/2026 a self-reported Unusual Incident Report (UIR) was filed with the Licensing Office. The facility reported that on 06/11/2026, Staff 1 (S1) gave Child 1 (C1) the wrong product instead of C1’s designated teething oil. S1 did not read the label of the oil applied. C1 was later observed to have red marks on their face. C1 was closely monitored by their authorized representative following the incident, and C1 did not show any other signs or symptoms at home.

During today's inspection, LPA conducted staff and parent interviews and obtained pertinent documents.

During interviews, all staff interviewed confirmed that they had either heard about or observed that C1 was given the wrong product instead of their designated teething oil.

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NAME OF LICENSING PROGRAM MANAGER: Tina Nguyen
NAME OF LICENSING PROGRAM ANALYST: Kathy Trinh
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2026
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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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: CAPSTONE MONTESSORI SCHOOL
FACILITY NUMBER: 304371681
VISIT DATE: 06/23/2026
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(Page 2)

Staff 1 (S1) stated that they were applying oil from C1’s bag since they were fussy. S1 and Staff 2 (S2) recalled C1 crying after the oil was applied. S1 then gave C1 water before taking the classroom outside. Three staff interviewed stated that they had observed red marks on C1’s face when the children were playing outside. S1 and S2 were unsure if the redness was from C1 falling or from the oil applied. Staff 3 (S3) then asked S1 to show them what product was used, and it was determined that C1 was given Oregano Spirits, an herbal supplement intended for immune support. S1 stated that they took full responsibility for the incident and did not know whether the oil applied belonged to C1 or not. S1 and S2 added that the children’s teething oils and gels were mixed up in the classroom's bin. S1 then informed C1’s authorized representative of the incident through verbal communication later that day.

Following the incident, Director, Angela conducted an internal investigation into the incident and concluded that C1 was given Oregano Spirits instead of their teething gel. To prevent a similar incident from occurring again, Angela stated that prescription and non-prescription children’s products are now stored inside the director’s office. The director is now responsible for administering the medication or other health related products besides sunscreen or diaper ointments. Also, the facility has implemented a new organizational system where children’s health related products are color coded and labeled with the children’s names.

During record review, the incident report confirmed that S1 gave C1 oregano oil drops instead of their teething gel. C1 had a rash around their face and mouth/teeth. The staff then rinsed C1’s mouth with water. C1’s authorized representative was informed of the incident in person on 6/11/2026. C1’s authorized representative reviewed and signed the incident report on 6/23/2026.

LPA also obtained a photo of the redness that C1 experienced following the incident as the children were playing outside. There were uneven patches of redness on the left-hand side of C1’s face from below their eye, down to their chin.

Additionally, LPA verified that C1 has a Parent Consent for Administration of Medications and Medication Chart (LIC 9221) for their teething gel.

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NAME OF LICENSING PROGRAM MANAGER: Tina Nguyen
NAME OF LICENSING PROGRAM ANALYST: Kathy Trinh
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2026
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: CAPSTONE MONTESSORI SCHOOL
FACILITY NUMBER: 304371681
VISIT DATE: 06/23/2026
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(Page 3)
In the areas that were evaluated, the facility was not in compliance and is in violation of the California Code of Regulations, Section 101223(a)(2). The deficiency is being cited on the attached LIC 809D.

A notice of site visit was given to facility representative and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Exit interview conducted and report was reviewed with the director, Angela Briones. Appeal Rights were explained. The Licensee was provided a copy of 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. First level appeals should be sent to the regional manager to the address listed above.

End of report.

NAME OF LICENSING PROGRAM MANAGER: Tina Nguyen
NAME OF LICENSING PROGRAM ANALYST: Kathy Trinh
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/23/2026 01:21 PM - It Cannot Be Edited


Created By: Kathy Trinh On 06/23/2026 at 12:50 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: CAPSTONE MONTESSORI SCHOOL
FACILITY NUMBER: 304371681

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/23/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/23/2026
Section Cited
CCR
101223(a)(2)

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(a) The licensee shall ensure that each child is accorded the following personal rights:
(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
This requirement was not as evidenced by:
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Director stated that they had conducted a staff training on the licensing regulations, staff expectations, parent communications, and more. Director provided LPA with a copy of the training agenda and the staff sign in sheet.
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Based on interviews and record reviews, the facility did not comply with the section above in that S1 gave C1 was Oregano Spirits instead of their teething oil which caused C1 to have a rash.
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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:
Kathy Trinh
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/23/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2026


LIC809 (FAS) - (06/04)
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