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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371289
Report Date: 09/22/2023
Date Signed: 09/22/2023 04:45:26 PM

Document Has Been Signed on 09/22/2023 04:45 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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:LITTLE THINKERS MONTESSORI ACADEMYFACILITY NUMBER:
304371289
ADMINISTRATOR:KALUGAMPITIYA, LILAMANIFACILITY TYPE:
850
ADDRESS:34240 CAMINO CAPISTRANOTELEPHONE:
(949) 488-7939
CITY:CAPISTRANO BEACHSTATE: CAZIP CODE:
92624
CAPACITY: 65TOTAL ENROLLED CHILDREN: 65CENSUS: 20DATE:
09/22/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:KALUGAMPITIYA, LILAMANITIME COMPLETED:
05:15 PM
NARRATIVE
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LPA tour the facility while conducting an announce visit for the purpose of providing findings. During the LPA's walk through the LPA observed a play structure that is not anchored to the floor.

LPA consulted the director on 7/26/2023 regarding the non-anchored structure. The LPA observed the non anchored item on 8/17/2023 and sent a courtesy emailed to the facility on 8/28/2023 with the regulation.

Today during the tour the LPA observed the non-anchored structure still in the yard children use to play. In addition a large palette with substances "tile" were observed in the playground children play in. The director state it was delivered today 9/22/2023 and it contains cushion like tiles that will be placed in the infant play ground.

The following violations of the California Code of Regulations, Title 22; Division 12, were observed and cited today: 101239(o)

Due to the Type A violations 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 them to the parents/guardians of children newly enrolled at the facility during the next 12 months. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. In addition, the licensee shall immediately post upon receipt of the Proof of Correction for 30 consecutive days.
Notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee KALUGAMPITIYA, LILAMANI.

Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2023
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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Document Has Been Signed on 09/22/2023 04:45 PM - It Cannot Be Edited


Created By: Araceli Bootorabi On 09/22/2023 at 04:27 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: LITTLE THINKERS MONTESSORI ACADEMY
FACILITY NUMBER: 304371289

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/27/2023
Section Cited
CCR
101239(o)

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(o)Playground equipment shall be securely anchored to the ground unless it is portable by design. Based on observation and interviewing the director, the licensee did not comply with the section cited above in by means of having an unachored playground equipment in the playground
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The director stated she would be working on getting it anchored or removed. The director stated that children would not be using it while the structure gets anchored to the ground.
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which poses an immediate health, safety or personal rights risk to 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:Patricia Magana
LICENSING EVALUATOR NAME:Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:
DATE: 09/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/22/2023


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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: LITTLE THINKERS MONTESSORI ACADEMY
FACILITY NUMBER: 304371289
VISIT DATE: 09/22/2023
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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 at the address listed above. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817.


A copy of 101239 Regulations was provided.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2023
LIC809 (FAS) - (06/04)
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