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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371418
Report Date: 09/09/2024
Date Signed: 09/09/2024 11:58:21 AM

Document Has Been Signed on 09/09/2024 11:58 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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:LAGUNA NIGUEL MONTESSORI CENTERFACILITY NUMBER:
304371418
ADMINISTRATOR/
DIRECTOR:		HOWARD, ATHANAFACILITY TYPE:
850
ADDRESS:28083 MOULTON PARKWAY # BTELEPHONE:
(949) 643-1200
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY: 174TOTAL ENROLLED CHILDREN: 174CENSUS: 52DATE:
09/09/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:Director, Athana HowardTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
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Licensing Program Analyst (LPA), Mahnaz (Nancy) Malek conducted an onsite case management inspection for the purpose of a self report Unusual Incident Report (UIR) sent to our office by the facility on 8/30/2024. LPA met with director, Athana Howard. LPA took census. There were a total of 52 preschool children with total of 8 staff in different classrooms and outside on the playground. Room # 1 four children with one staff on the playground, Room # 2 thirteen children with three staff on the playground, Room # 3 not in use, Room # 4 not in use, Room # 5 sixteen children with two staff, and Room # 6 nineteen children with two staff observed.
According to the self incident report, on Thursday August 29, 2024 at approximately 5:30 pm it was witnessed that Staff # 1 grabbed the back of Child # 1's neck during outside time.

A review of the Facility Personnel 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.

LPA interviewed the director, staff # 1 and staff # 2, staff # 3. and C1 who had knowledge regarding the incident. During the course of interviews with staff, S1 admitted that they grabbed C1 with the side of the neck and pinched C1 on the right side of the neck. S1 stated they were stressed out because C1 was not listening. LPA interviewed S2 who was with S1 on the playground during the incident time. S2 stated they did not observe the incident but S1 admitted to S2 that they pinched C1. LPA also interviewed Adult # 1 who was a witness for this incident. A1 stated S1 grabbed C1 from back of C1's neck pushing C1 from backwards. The incident was observed on the playground.
Continued on page 2
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE: DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2024
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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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: LAGUNA NIGUEL MONTESSORI CENTER
FACILITY NUMBER: 304371418
VISIT DATE: 09/09/2024
NARRATIVE
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LPA interviewed seven other staff who were present today. LPA interviewed nine qualified children including children who were present during the incident. LPA also interviewed C1 today. Children did not disclose any information regarding the incident.

LPA reviewed the outside camera with the director for the mentioned times and date. The area of the incident where the incident happened was out of the capture of the cameras.

Type A under California Title 22 Regulations Section 101223(a)(3) Personal Rights of children is cited on 9099D next page.



The director, Athana Howard was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. Notice of Site Visit must be posted on or adjacent to the door. Failure to post will result in Civil Penalties of $100.00. LPA Malek informed the director, Athana Howard that this report dated 9/9/2024 documents type A citation shall be posted for 30 consecutive days as there is immediate risks to the health, safety, or personal rights of children in care. Also, LPA Malek informed the director, Athana Howard to provide a copy of this licensing report dated 9/9/2024 that documents any Type A citation 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. The director, Athana Howard was provided with 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.

The exit interview was conducted with director, Athana Howard.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/09/2024 11:58 AM - It Cannot Be Edited


Created By: Mahnaz Malek On 09/09/2024 at 09:15 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: LAGUNA NIGUEL MONTESSORI CENTER
FACILITY NUMBER: 304371418

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/10/2024
Section Cited
CCR
101223(a)(3)

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Personal Rights-The licensee shall ensure that each child is accorded the following personal rights: To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of
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Director stated the school took disciplinary action towards S1. The director agreed to send a statement with the staffs' names and signatures acknowledging the section on the personal rights of children. The proof of correction will be sent to LPA's email address by the due date of 9/10/2024
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a ..............
This requirement was not met as evidenced by A1 witnessing S1 and S1 admitting they pinched C1 on the right side of the C1's neck due to C1 not listening. This is an immediate risk to the health and safety of children in care.
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The director will follow up with staff watch the videos regarding children's personal rights in childcare at the Department's website of: https:/ccld.childcarevideos.org.
The proof of watching the videos will be sent to LPA by 9/22/2024.

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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:Thuy Ho
LICENSING EVALUATOR NAME:Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:
DATE: 09/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2024


LIC809 (FAS) - (06/04)
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