<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371150
Report Date: 07/25/2024
Date Signed: 07/25/2024 02:42:27 PM

Document Has Been Signed on 07/25/2024 02:42 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:INT'L CHRISTIAN MONTESSORI ACADEMY OF COSTA MESAFACILITY NUMBER:
304371150
ADMINISTRATOR/
DIRECTOR:		MARIA TEELFACILITY TYPE:
830
ADDRESS:2950 MCCLINTOCK WAYTELEPHONE:
(714) 966-0303
CITY:COSTA MESASTATE: CAZIP CODE:
92626
CAPACITY: 22TOTAL ENROLLED CHILDREN: 22CENSUS: 7DATE:
07/25/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Maria Teel, DirectorTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Tran conducted an unannounced Case Management - Legal/Non-Compliance for the purpose of ensuring the facility is in compliance with California Title 22 Regulations, Health and Safety Codes and Stipulation and Waiver, and Order # 6622306102-B dated 04/10/2024. LPA Tran arrived at the facility at approximately 9am and entered through the front door of the facility without the need to enter the code on the security lock pad on the front entrance door. LPA Tran also able to open the second door in the hallway to gain access to the classrooms without the need to enter the code on the security lock pad on the second hallway door. LPA Tran noticed the alarm device that was installed on the second door in hallway did not produce a sound. LPA Tran knocked on the Red classroom's door and was greeted by Staff #1, who informed LPA that facility's Director was on their way. LPA proceeded to inspect the Infant classroom. At approximately 9:15am, Director Maria Steel arrived to the facility and met with LPA Tran at the Infant classroom. LPA Tran informed the Director the purpose of the visit. LPA Tran and the facility representative toured the facility inside and outside, and the floor and yard plan (LIC 999) were verified. Census was taken in individual classrooms. The overall census observed was 3 infants and 2 staff members in the Infant's room and 4 toddlers and 1 staff members in the Toddler's room. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staff to child ratios. Facility hours are 7a.m.- 6p.m., Monday through Friday.

A review of the Facility Personnel Report Summary on this date 07/25/2024 indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

(Continue next page)
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2024
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 5
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: INT'L CHRISTIAN MONTESSORI ACADEMY OF COSTA MESA
FACILITY NUMBER: 304371150
VISIT DATE: 07/25/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
(Page 2 of Report)

During the inspection of the indoor activity space, items which could pose a danger to children (detergents, cleaning compounds, and medications) were observed to be stored out of the reach of children. Poisons/Hazardous Items are not kept on the premises. Food is prepared on site; snacks are provided as needed. Bottles and food containers brought from home are properly labeled with name and date and other refrigerated items. Trash receptacles containing solid waste have tight fitting lids. Food prep areas were clean and sanitary. Food is properly stored. Menus are posted where they can be reviewed by parents. Floors, equipment, and furniture were clean and observed to be in good repair and free of sharp edges. There is drinking water available to children indoors by Arrowhead water container and disposable cups. The children's bathrooms are clean and sanitary. Changing table has raised sides at least three inches high and is within an arm’s reach of a hand washing sink. Toys observed to be clean age appropriate. Children nap on cots and cribs, bedding is stored individually and is changed daily. Sleep logs are documented on Brightwheel app and kept in the napping area. The facility has conducted an emergency drill within the past six months and keeps documentation of drills. The facility has a at least one working smoke detector, one working carbon monoxide detector and at least one functioning fire extinguisher. Facility meets all posting requirements.

The outdoor activity space was inspected for compliance. Required shade, drinking water and fencing were inspected. The playground is enclosed by a fence at least four feet in height and is in good repair. The surface of the outdoor activity space is maintained and free of hazards. The cushioning material around outdoor play equipment and other similar equipment appeared to be enough to absorbs falls. Drinking water in the outdoor activity space is provided by Arrowhead water container and disposable cups. The outdoor equipment and toys are in good repair and free of sharp edges. There are no bodies of water present at the facility. The inspected outdoor facility grounds are safe, sanitary and in good repair. Playground gate was checked and no alarm device was installed on this gate.

Staff files were reviewed for staff present during the facility inspection on this date. Proof of immunization against pertussis, measles for staff members were reviewed and within compliance. Beginning March 31, 2018, H&S Code 1596.8662 requires all directors and employees to complete mandated reporting training, and to renew the training every two years. All reviewed staff files has current Mandated Reporter training certificate. At least one staff member present possesses current EMSA approved Pediatric CPR/First Aid certifications, which expires 04/2025. (Continue next page)
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: INT'L CHRISTIAN MONTESSORI ACADEMY OF COSTA MESA
FACILITY NUMBER: 304371150
VISIT DATE: 07/25/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
(Page 3 of the Report)

Children's records were reviewed, and there was a separate, complete and current record for each child. LPA observed and reviewed LIC 9227 Individual Infant Sleeping Plan in children’s files. Care and supervision was evaluated to determine if the basic needs of infants are met and appropriate. Infant Needs and Assessments are done quarterly or updated as needed. In the areas reviewed the children’s files were found to be in full compliance. Sign in/out procedure was reviewed for compliance. The person who signs the child in and out uses their unique log in via Brightwheel application and records the time of the day.

During the inspection, LPA observed facility's one of one alarm device that was installed on the hallway door did not function appropriately. When interviewed, Director stated she checked the alarm yesterday evening and it was functioning. LPA and Director tested the alarm five additional times. First test, alarm did not sound when door was opened. Second test, alarm did not sound when door was opened. Third test, alarm sounded when door was opened. Fourth test, alarm did not sound when door was opened. Fifth test, alarm did not sound when door was opened. Facility Director called facility maintenance staff at 9:45am to request for the alarm device and lock on the security key pads to be fixed. Maintenance staff arrived at approximately 10 am and fixed the lock on security lock pads on the front entrance and the hallway door. Maintenance staff removed the current alarm device from the hallway door and stated they were going to purchase new alarm devices to install on all exit doors.

According to Stipulation and Waiver, and Order # 6622306102-B dated 04/10/2024, Section E. Egress Devices: Within thirty (30) days of the effective date of this Stipulation, Respondents shall install devices on each door that allows for ingress or egress to the facilities and shall maintain them in good working order. The devices shall emit a noise sufficient to alert respondents of staff when a door to the outside of the facilities is being opened. The devices must remain on during facilities business hours.

LPA addressed concern with facility's Director regarding failure to comply to Stipulation and Waiver, and Order # 6622306102-B dated 04/10/2024, Section E. Egress Device, as followed:
1- Facility has only one alarm device installed on the hallway door that leads to the front entrance door and to the classroom.
2- The alarm device that was installed on the hallway door, did not function appropriately during today's visit. (Continue next page)
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: INT'L CHRISTIAN MONTESSORI ACADEMY OF COSTA MESA
FACILITY NUMBER: 304371150
VISIT DATE: 07/25/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
(Page 4 of Report)

Based on LPA's observations, record reviews and interviews, the following violation was observed, in accordance with California Health and Safety Code Section 1596.885(c) for Conduct Inimical, is being cited on the attached LIC 809D.

Due to the Type A violation being cited today, the licensee shall post and provide copies of the report to parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. Failure to post Type A reports for 30 days will result in a Civil Penalty of $100.00.

Appeal Rights and deficiencies were discussed. The facility representative was provided a copy of their 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. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director Maria Teel.

(End of Report)
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 07/25/2024 02:42 PM - It Cannot Be Edited


Created By: Nguyen K Tran On 07/25/2024 at 01:52 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: INT'L CHRISTIAN MONTESSORI ACADEMY OF COSTA MESA
FACILITY NUMBER: 304371150

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/25/2024
Section Cited
HSC
1596.885(c)

1
2
3
4
5
6
7
Health and Safty Code 1596.885 Denial, suspension or revocation of license... The department may... suspend or revoke any license... under this act upon any of the following....(c) Conduct which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility.... This requirement is not met evidenced by:
1
2
3
4
5
6
7
During today's visit, facility maintenance staff installed 3 new alarm devices: one on front entrance door, one on hallway door and one on the gate of the facility's playground. Director states she will submit a detailed plan to ensure the alarm devices are in working order during operation hours.
8
9
10
11
12
13
14
Based on observation, interview and record review, the licensee did not adhere to the Stipluation Order regarding Egress devices - (1) Facility has only one alarm device installed on the hallway door, and (2) The alarm device that was installed on the hallway door, did not function appropriately during today's visit, which posed an immediate health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Martha Malane
LICENSING EVALUATOR NAME:Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:
DATE: 07/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/25/2024


LIC809 (FAS) - (06/04)
Page: 5 of 5