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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300614024
Report Date: 12/20/2022
Date Signed: 12/20/2022 12:03:24 PM

Document Has Been Signed on 12/20/2022 12:03 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:MONTESSORI EDUCATION CENTERFACILITY NUMBER:
300614024
ADMINISTRATOR:HALE, KATHLEENFACILITY TYPE:
850
ADDRESS:1658 BROADWAYTELEPHONE:
(714) 991-7400
CITY:ANAHEIMSTATE: CAZIP CODE:
92802
CAPACITY: 61TOTAL ENROLLED CHILDREN: 61CENSUS: 20DATE:
12/20/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Kathleen Hale - DirectorTIME COMPLETED:
12:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Odom conducted an unannounced Case Management visit. LPA Odom met with Director Kathleen Hale, took a tour of the facility and took census, LPA observed 4 staff members and 20 preschool age children. LPA discussed the Lead Sampling Testing conducted on 11/12/22 with Director. LPA Odom ensured the Lead Sample Report is posted. Licensee was advised on 12/12/22 the Lead Sample Report was to be posted; LPA confirmed the Licensee posted the Sample Report.

Director stated the outlets with high levels of Lead are inoperable. Outlet A is a drinking fountain in the Practical Life Room that will be remediated, the drinking fountain was closed off with a blue plastic cover and a sign that says, “Out of Service”. Director stated they plan to remediate the outlet, the drinking fountain was ordered on 12/11/22, and director will schedule to retest the outlet. Source of drinking water is children’s water bottles brought from home and refilled by staff using water jugs with cups.

Based on LPAs record reviews the following violation was observed and is being cited in accordance with California Code of Regulations Title 22, Division 12, Chapter 3, Section 101700.3 California Lead Action Level at Child Care Centers is being cited on the attached LIC 809D.

Exit interview conducted and report was reviewed with the Director Kathleen Hale. A notice of site visit was given and must remain posted for 30 days.



Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) 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.
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Carmen Odom
LICENSING EVALUATOR SIGNATURE: DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 12/20/2022 12:03 PM - It Cannot Be Edited

Citations on this Visit Report are Under Appeal!


Created By: Carmen Odom On 12/20/2022 at 11:55 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: MONTESSORI EDUCATION CENTER
FACILITY NUMBER: 300614024

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type B
12/20/2022
Section Cited

101700.3

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101700.3 California Lead Action Level at Child Care Centers (b) Testing results with fractional ppb readings of 0.5 ppb or greater shall be rounded up to the nearest whole number, before comparing to the Action Level. (1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement was not met as evidenced by:
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Director posted the lead sampling test results. Director closed off the outlets with plastic and sign posted. Director is utilizing water jugs as another source of water and using personal water bottles as source of drinking water. Director stated they will replace the faucets and will schedule a test date. Director will send retest form to licensing office by 01/20/23.
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Based on facility Lead sampling tests it was discovered that Outlets A had high level of lead. This poses a potential risk to the health of children 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:Judy Hanson
LICENSING EVALUATOR NAME:Carmen Odom
LICENSING EVALUATOR SIGNATURE:
DATE: 12/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/20/2022


LIC809 (FAS) - (06/04)
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