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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300614024
Report Date: 04/25/2025
Date Signed: 04/25/2025 10:03:17 AM

Document Has Been Signed on 04/25/2025 10:03 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:MONTESSORI EDUCATION CENTERFACILITY NUMBER:
300614024
ADMINISTRATOR/
DIRECTOR:		HALE, KATHLEENFACILITY TYPE:
850
ADDRESS:1658 BROADWAYTELEPHONE:
(714) 991-7400
CITY:ANAHEIMSTATE: CAZIP CODE:
92802
CAPACITY: 61TOTAL ENROLLED CHILDREN: 61CENSUS: 10DATE:
04/25/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:10 AM
MET WITH:Director, Kathleen HaleTIME VISIT/
INSPECTION COMPLETED:
10:05 AM
NARRATIVE
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Licensing Program Analyst (LPA) Cynthia Sun conducted a follow-up Case Management Incident inspection, in response to an Unusual Incident Report submitted to the Licensing office on 02/14/2025. LPA met with the Director, Kathleen Hale. There was a total of 10 preschool children and 2 staff present at the facility. During today’s inspection the facility was operating within its licensed capacity and within compliance of staffing ratios.

A review of the Facility 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.

On 02/14/2025 a self-reported Unusual Incident Report (UIR) was filed with the Licensing Office. The facility reported on February 13, 2025; Staff #1 (S1) had given child #1 (C1) cashews supplied by the S1. S1 knew C1 is allergy to nut but forgot. Soon after, C1 had an allergic reaction. C1’s eyes were getting red. Parent #1 (P1) was notified. P1 is also a nurse advised facility to administer EpiPen to C1 and that P1’s friend would come to pick C1 up. When P1’s friend arrived at the facility, P1’s friend administered the EpiPen to C1 and took C1 home.

During the inspection on 2/21/25 a physical plant inspection was conducted, census of children was taken, and staff were interviewed.

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NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Cynthia Sun
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/25/2025
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: MONTESSORI EDUCATION CENTER
FACILITY NUMBER: 300614024
VISIT DATE: 04/25/2025
NARRATIVE
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On 02/20/2025, LPA interviewed P1. P1 stated on 2/13/25 around noon P1 received a call from the facility site supervisor reporting that C1 had eaten a nut and requested if P1 wanted to pick up C1. P1 stated they were unable to pick up C1 due to work. P1 stated they begged for S1 and S2 to administer EpiPen and Site Supervisor insisted for P1 to pick-up C1. When all this was happening, P1 then called P1’s friend, Adult #1 (A1) to go to the facility to pick up C1. A1 arrived at the facility, administered EpiPen to C1 and took C1 home. C1 did not return to facility the next day because it was a holiday and P1 was nervous there would be special Valentine Day treats in the facility. C1 returned to the facility on Monday 2/17/25. P1 stated child was fine.

On 02/21/2025, LPA interviewed 3 staff. Staff #1 (S1) stated on 2/13/25 at naptime S1 was eating cashews and when C1 woke up from nap C1 asked S1 for a cashew. C1 then took the cashew from S1’s hand and ate it. S1 forgot C1 had a nut allergy. C1 was fine then C1 started scratching C1’s neck and under eyes turned blue. S1 stated S1 has been trained by Staff #3 (S3) to administer medication. S1 also stated S1 did not administer the EpiPen due to A1 grabbing it and administering it to C1. S1 stated when S1 came back with the epi-pen, S1 stated S1 did not administer epi-pen because A1 had arrived at facility. S1 disclosed S3 is the designated staff that deals with the children’s medications. S1 stated to prevent this from happening again, S1 will not share the food with the children.

Staff #2 (S2) stated on 2/13/25 at around 1:30 PM S2 was informed by S1 that C1 who was allergic to nut ate a nut. S2 checked the wellness of C1 and did not observe any symptoms. S2 called P1 to inform P1 C1 had eaten nut and to ask P1 to pick C1 up. Around 1:40 pm C1 was observed with itchy eyes and was throwing up. S2 called P1 back immediately to inform P1 C1 was having allergic reaction. Around 2:00 PM A1 later arrived at facility. S2 stated S2 did not give epi-pen because A1 arrived at facility and P1 asked A1 to administer epi-pen. A1 administered the epi-pen on C1. S2 did not administer the epi-pen because A1 took it and administered it to C1. S2 stated S2 was trained to administer medication to children and S3 is the designated staff that deals with the children’s medications.

S3 stated S3 was not present on 2/13/25 when the incident happened. S3 stated staff are trained in administering medication but is unsure why staff did not administer the epi-pen. S3 stated they will post the allergy list inside all the classroom’s cabinet door. Staff will not be allowed to bring nuts or nut products into facility and S3 will request for P1 to train all staff on how to administer the epi-pen.

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NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Cynthia Sun
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/25/2025 10:03 AM - It Cannot Be Edited

Citations on this Visit Report are Under Appeal!


Created By: Cynthia Sun On 04/25/2025 at 08:49 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: 04/25/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type A
04/25/2025
Section Cited
CCR
101223(a)(8)

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101223(a)(8) Personal Rights. Each child shall have the right to receive or reject medical care, or health-related services, except for minors for whom a guardian, conservator or other legal authority has been appointed.This requirement was not met as evidence by:
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Director stated they had Parent who is a nurse come out to facility and conduct a training for staff involved. Director met wuth staff involved and went over basic tarining on what to do in those case sitations.
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Based on LPA's interviews, and record review, S1 gave C1 cashew which C1 was known to be allergic to and staff failed to administer EpiPen to C1 immediately as directed by C1’s parent & physician. Staff also failed to seek outside medical treatment immediately to help C1. This poses an immediate risk to the child's health and safety.
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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.
Thuy Ho
NAME OF LICENSING PROGRAM MANAGER:
Cynthia Sun
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/25/2025


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: MONTESSORI EDUCATION CENTER
FACILITY NUMBER: 300614024
VISIT DATE: 04/25/2025
NARRATIVE
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LPA reviewed C1’s file. LPA observed C1’s file contained a “Parent/Guardian and Authorized Health Care Provider Request for Medication” signed by C1’s parents with approval of the EpiPen due to food allergy. LPA also observed C1’s physician report to have nut allergy listed.

Based on LPA's interviews, and record review, it has been determined that S1 gave C1 cashew which C1 was known to be allergic to and staff failed to administer EpiPen to C1 immediately as directed by C1’s parent & physician. Staff also failed to seek outside medical treatment immediately to help C1. The facility was not in compliance with California Code of Regulations, Title 22, Division 12. The following citation: Personal Rights 101223(a)(8), is being cited on the attached 809D.

Also, LPA Sun informed Director Kathleen Hale to provide a copy of this licensing report dated 4/25/2025 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with Director Kathleen Hale A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

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End of Report.

NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Cynthia Sun
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2025
LIC809 (FAS) - (06/04)
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