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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371421
Report Date: 05/31/2023
Date Signed: 05/31/2023 04:44:06 PM

Document Has Been Signed on 05/31/2023 04:44 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:MAGICAL STAR MONTESSORI-PRESCHOOLFACILITY NUMBER:
304371421
ADMINISTRATOR:VITHANAGE, IRA DAYANIFACILITY TYPE:
830
ADDRESS:1636 WEST CATHERINE DRIVETELEPHONE:
(714) 696-1241
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 8DATE:
05/31/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Director Ira VithanageTIME COMPLETED:
02:30 PM
NARRATIVE
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On 05/31/2023, Licensing Program Analyst (LPA) Romy Castanon conducted a Case Management due to deficiencies observed during today's inspection. LPA toured the infant classroom and census was taken. LPA observed two staff with five napping children on an area rug and two infants in cribs.

During the infant room tour, LPA observed a small brown bean shaped pillow inside the crib with Infant #1. Staff #1 (S1) was hovering over Infant #2 in their crib. S1 was shaking rattle toys that were linked together. The toy was clipped on the side of the crib and was long enough for the Infant #2 to grasp in their hands.

Based on LPA’s observation, the facility is being cited in accordance with California Code of Regulations, Title 22, Division 12, Section 101439.1(f) and (f)(3) Infant Care Center Sleeping Equipment.

Appeal Rights 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 Director Ira Vithanage. (End of Report)

SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Romelia M Castanon
LICENSING EVALUATOR SIGNATURE: DATE: 05/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/31/2023
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 05/31/2023 04:44 PM - It Cannot Be Edited


Created By: Romelia M Castanon On 05/31/2023 at 03:52 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: MAGICAL STAR MONTESSORI-PRESCHOOL
FACILITY NUMBER: 304371421

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/31/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/07/2023
Section Cited
CCR
101439.1(f)

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101439.1 Infant Care Center Sleeping Equipment (f) Cribs shall be free from all loose articles and objects, including blankets and pillows. Thid requirement was not met as evidenced by:
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Director will conduct a safe sleep traning with infant care staff or other staff that may be needed in the infant room. Director will provide LPA with topics and attendance sheet signed by staff who attended by POC date.
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LPA observed Infant #1 laying in crib with a small brown bean shaped pillow. This poses a potential risk to the health, safety or personal rights risks to the children in care.
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Type B
06/07/2023
Section Cited
CCR101439.1(f)(3)

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101439.1 Infant Care Center Sleeping Equipment (f) Cribs shall be free from all loose articles and objects... (3) There shall be no objects hanging above or attached to the side of the crib. This requirement was not met as evidenced by:
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During visit Director posted a signed document with safe sleep regualtions as a reminder to staff. Director will conduct a safe sleep traning with infant care staff or other staff that may be needed in the infant room and email topics and signed attendance sheet to LPA by POC date.
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LPA observed Staff #1 (S1) was hovering over Infant #2 in their crib. S1 was shaking rattle toys that were linked together. The toy was clipped on the side of the crib and was long enough for the Infant #2 to grasp in their hands. This poses a potential risk to the health, safety or personal rights to the 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:Rina Lopez
LICENSING EVALUATOR NAME:Romelia M Castanon
LICENSING EVALUATOR SIGNATURE:
DATE: 05/31/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/31/2023


LIC809 (FAS) - (06/04)
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