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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371150
Report Date: 11/18/2022
Date Signed: 11/18/2022 11:30:45 AM

Document Has Been Signed on 11/18/2022 11:30 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:INT'L CHRISTIAN MONTESSORI ACADEMY OF COSTA MESAFACILITY NUMBER:
304371150
ADMINISTRATOR:MARIA TEELFACILITY TYPE:
830
ADDRESS:2950 MCCLINTOCK WAYTELEPHONE:
(714) 966-0303
CITY:COSTA MESASTATE: CAZIP CODE:
92626
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 14DATE:
11/18/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Director, Maria Teel TIME COMPLETED:
11:45 AM
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A Follow up Case Management Incident inspection was conducted on this day by Licensing Program Analysts (LPAs) Dianna Valdez Santana and LPA Giselle Lucero. LPAs met with Maria Teel, Director who gave a tour of the facility. Census was taken. There were 14 infant children present upon arrival. A review of staff records indicates all facility staff or individuals who require caregiver background checks have received a criminal record clearances or exemptions and a child abuse index clearance.

The initial inspection was conducted in response to an Unusual Incident Report received on 10/13/2022, in which child #1 had left the classroom and wandered out of the facility and into the street. Director filed report with the Department on 10/13/22. This incident was reported to licensing in a timely fashion, compliant with reporting requirement regulations. An inspection was conducted on 10/14/2022, to investigate into this unusual incident.

During the course of the investigation, staff involved in the unusual incident report were interviewed, a physical plant inspection was conducted, and census of children was taken. During the inspection on 10/14/22, the facility had 5 staff and 15 children present.

During today’s visit 5 staff were interviewed including the Director and documents were obtained. No deficiencies were found, and facility was in compliance.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE: DATE: 11/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2022
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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