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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370501
Report Date: 12/20/2022
Date Signed: 12/20/2022 10:17:50 AM

Document Has Been Signed on 12/20/2022 10:17 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:MY FIRST MONTESSORIFACILITY NUMBER:
304370501
ADMINISTRATOR:WENDY MARTINFACILITY TYPE:
850
ADDRESS:19118 BROOKHURST STREETTELEPHONE:
(714) 962-2620
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92646
CAPACITY: 231TOTAL ENROLLED CHILDREN: 231CENSUS: 52DATE:
12/20/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Wendy Newton, DirectorTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Tran conducted a case management inspection to follow up on a self-report unusual incident that was submitted to CCL Regional Licensing Office on 12/14/2022. It was reported by Wendy Newton, Director. According to Mrs. Newton, the unusual incident occurred on 12/13/2022, when child #1 (C1) sustained an injury on the right elbow from falling while the climbing ladder in the play yard during outside time.

A review of staff 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. During today's inspection staff members were interview and a tour of the facility was conducted. There were a total of 4 toddlers and 3 staff in the toddler room and 48 preschool and 6 staff in 2 different classrooms. Facility meets capacity and staff-to-child ratio. LPA interviewed Director Newton and Admin staff Martinez. LPA Tran also obtained staff's schedule as well as children roster/attendance sheet for the date of the incident. The playground was inspected and pictures of the location of the incident were obtained.

Due to insufficient information available at this time and further interviews needed, the above incident need further investigation.

Exit interview was conducted. The Notice of Site Visit was posted. Director was advised the Notice of Site Visit must be posted for 30 days or 100$ Civil Penalty will be assessed.


(End of Report)
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
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)
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