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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371431
Report Date: 10/13/2025
Date Signed: 10/15/2025 11:30:18 AM

Document Has Been Signed on 10/15/2025 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:MONTESSORI HARBOR MESA SCHOOLFACILITY NUMBER:
304371431
ADMINISTRATOR/
DIRECTOR:		DE FRENZA, GIULIANAFACILITY TYPE:
850
ADDRESS:3025 DEODAR AVENUETELEPHONE:
(714) 549-3803
CITY:COSTA MESASTATE: CAZIP CODE:
92626
CAPACITY: 63TOTAL ENROLLED CHILDREN: 63CENSUS: 18DATE:
10/13/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:12 PM
MET WITH:Facility Representative, Samantha GonzalezTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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On 10/13/2025, Licensing Program Analyst (LPA), Deschampe conducted an on-site inspection for the purpose of an Unannounced Annual Random-Case Management/Annual Continuation inspection which began on 10/09/2025. LPA completed the physical plant and partial staff record review on 10/09/2025 but due to time constraints had to continue the inspection today. LPA arrived at the Child Care Center (CCC) at 12:12 PM and was granted entry by the teacher, Susana Mayer. Facility Representative/Director (FR), Samantha Gonzalez guided LPA on the inspection of the inside and outside of the CCC’s grounds. LPA took the following census: Room 2 had 6 children with 2 staff and Room 3 with 12 children and 2 staff.

During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. Facility hours are 7:00 AM - 6:00 PM, Monday through Friday. A review of the Facility Personnel Report Summary on this date, 10/13/2025 indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Facility Representative was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code (HSC) section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.
NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Susan Deschampe
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

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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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MONTESSORI HARBOR MESA SCHOOL
FACILITY NUMBER: 304371431
VISIT DATE: 10/13/2025
NARRATIVE
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During the inspection of the indoor activity space, items which could pose a danger to children (detergents and cleaning compounds) were observed to be stored and out of reach of children. Poisons are not kept on the premises. Firearms and other weapons are not allowed on or stored on the premises. Medications are centrally stored and inaccessible to children. First-aid supplies (checked regularly) were complete and stored in a location in each classroom that is accessible to staff but inaccessible to children. Food is primarily brought from the family home, however, there is food available if necessary. Snacks and milk/water are prepared and provided on-site. Food is properly stored. Food preparation areas were clean and sanitary. A snack menu is posted where they could be reviewed by parents/authorized representatives. Children have access to drinking water via personal labeled water bottles, with additional water supplied by water bottles.

Fixtures, furniture, equipment, and supplies were clean and observed to be in good repair, free of sharp edges, and age appropriate for all children enrolled in care. The children's and staff bathrooms are safe and in sanitary operating condition. Children nap on mats which are properly stored. Children's personal items, including bedding is clean, stored separately and individually, and in a labeled compartment. Personal bedding is brought home every Friday to be laundered by family. The facility has conducted an emergency drill within the past six months (09/08/2025). LPA observed testing of the carbon monoxide/smoke detectors throughout the facility. City of Costa Mesa Fire and Rescue Department is scheduled for an annual inspection on 10/26/2025. There are 2 fire extinguishers on site. The facility maintains an indoor temperature within regulation (minimum of 68 degrees and maximum of 85 degrees, in extreme heat a maximum of 20 degrees less than the outside temperature.) Facility met all waiver, exceptions, and posting requirements, including the California Child Passenger Safety Law, posted by the entrance of the facility.

The outdoor activity space was inspected for compliance. The facility grounds were safe, sanitary and in good repair. The playground was enclosed by a fence at least four feet in height. The surface of the outdoor activity space was well maintained and free of hazards. The cushioning material (rubber) around the climbing equipment, slides and other similar equipment appeared to be enough to absorbs falls. Drinking water in the outdoor activity space is provided by personal water bottles, disposable cups and water bottles. The outdoor equipment and toys were in good repair and free of sharp edges. There are no bodies of water on the facility grounds. Facility is a smoke free.
NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Susan Deschampe
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2025
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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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MONTESSORI HARBOR MESA SCHOOL
FACILITY NUMBER: 304371431
VISIT DATE: 10/13/2025
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California Childcare Health Program website: cchp.ucsf.edu/content/disaster-preparedness . Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org.

California Department of Social Services Lead Information Brochure was explained to the facility representative. Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the facility representative shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. Water Lead Testing was completed by Enthalpy Analytical per report dated 06/20/2023. LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding American with Disabilities Act (ADA) was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Staff files were reviewed for staff present during the facility inspection on this date, 5 out of 5 staff files were reviewed. Health screening and immunization as required were reviewed. Beginning September 1, 2016, Health and Safety (HSC) 1597.622 states, a person shall not be employed or volunteer at a child care center if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis and measles for staff were reviewed and within compliance. Beginning March 31, 2018, HSC 1596.8662 requires all directors and employees to complete mandated reporting training, and to renew the training every two years. At least one staff member present possesses current EMSA approved Pediatric CPR/First Aid certification.
NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Susan Deschampe
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2025
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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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MONTESSORI HARBOR MESA SCHOOL
FACILITY NUMBER: 304371431
VISIT DATE: 10/13/2025
NARRATIVE
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A random sample of 7 children's records were reviewed. There was a separate, complete and current record
for each child. In the areas reviewed 6 out of 7 children’s files were found to be in full compliance. California Code of Regulations (CCR) Section 101221 Child's Records (10) Record of current medications, including the name of the prescribing physician, and instructions, if any, regarding control and custody of medications. CCR Section 101226 Health-Related Services (e)(2) All prescription...medication shall be maintained with child's name and shall be dated. (e)(B) For each prescription medication,...approval and instructions from the child's authorized representative for the administration of the medication to the child. LPA completion of children's record review confirmed 1 out of 7 children's files did not meet these requirements. At 3:43 PM, LPA observed facility representative received document LIC 9221 Parent Consent for Administration of Medications and Medication Chart completed by authorized representative and placed in child's file. This poses a potential risk to children in care. Sign in/out is completed on paper by children's authorized representative.

LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

LPA also informed facility representative of the importance of checking for recalled children devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all devices with the CPSC to be notified of any recalls on purchased equipment.

The facility representative was informed that Licensing Quarterly Updates are available at www.ccld.ca.gov and may request to be added to an email list to receive a Quarterly Update from www.ccld.ca.gov and select Receive Important Updates link.

LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian
NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Susan Deschampe
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2025
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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MONTESSORI HARBOR MESA SCHOOL
FACILITY NUMBER: 304371431
VISIT DATE: 10/13/2025
NARRATIVE
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In the areas that were evaluated, Type B deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit. For further detail, refer to 809-D.

CCR 101221 Child's Records

CCR 101226 Health-Related Services

Exit interview conducted and report was reviewed with the facility representative/director, Samantha Gonzalez. Appeal Rights were discussed with facility representative. The facility representative was provided a copy of the 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 consecutive days. The “Notice of Site Visit” must be posted on, or immediately adjacent to, the interior side of the main door to the facility. Failure to post will result in Civil Penalties of $100.00.



To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

End of Report
NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Susan Deschampe
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/15/2025 11:30 AM - It Cannot Be Edited


Created By: Susan Deschampe On 10/13/2025 at 03:48 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: MONTESSORI HARBOR MESA SCHOOL
FACILITY NUMBER: 304371431

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/13/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101221(b)(10)
Child's Records
(b) Each record shall contain information including, but not limited to, the following: (10) Record of current medications, including the name of the prescribing physician, and instructions, if any, regarding control and custody of medications.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, staff interview, and record review, the licensee did not comply with the section cited above in 1 out of 7 chidlren's files which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/10/2025
Plan of Correction
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Facility Representative to obtain medical documentation from authorized representative regarding prescription.
Facility Representative to maintain medical documentation in children's file.
Type B
Section Cited
CCR
101226(e)(3)(B)
Health-Related Services
(3) Prescription medications may be administered if all of the following conditions are met: (B) For each prescription medication, the licensee shall obtain, in writing, approval and instructions from the child's authorized representative for the administration of the medication to the child.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, staff interview, and record review, the licensee did not comply with the section cited above in 1 out of 7 children's files which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/13/2025
Plan of Correction
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Facility Representative obtained signed documentation (LIC922) from authorized representative at 3:43 PM today 10/13/2025.
Facility Representative will maintain document in children's file.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Thuy Ho
NAME OF LICENSING PROGRAM MANAGER:
Susan Deschampe
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2025


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Document Has Been Signed on 10/15/2025 11:30 AM - It Cannot Be Edited


Created By: Susan Deschampe On 10/13/2025 at 03:56 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: MONTESSORI HARBOR MESA SCHOOL
FACILITY NUMBER: 304371431

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/13/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101226(e)(2)
(e)(2) All prescription and nonprescription medications shall be maintained with child's name and shall be dated.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, staff interview, and record review, the licensee did not comply with the section cited above in 1 out of 7 children's medications, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/10/2025
Plan of Correction
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Facility Representative spoke with authorized representative who will bring updated prescription in original container.
Facility Representative will create reminders to be current on medications on site.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Thuy Ho
NAME OF LICENSING PROGRAM MANAGER:
Susan Deschampe
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2025


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