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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304371438
Report Date: 03/04/2025
Date Signed: 03/04/2025 11:22:18 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/19/2024 and conducted by Evaluator Sarah Garcia
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20241119170935
FACILITY NAME:GAOWA MONTESSORI SCHOOLFACILITY NUMBER:
304371438
ADMINISTRATOR:MINGOLLA, TANYAFACILITY TYPE:
850
ADDRESS:1620 ADAMS AVENUETELEPHONE:
(714) 714-0055
CITY:COSTA MESASTATE: CAZIP CODE:
92626
CAPACITY:120CENSUS: 91DATE:
03/04/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Director, Donna KoontzTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Methamphetamine and Fentanyl found in baggy in facility restroom.
Reporting requirements.
Personal Rights.
INVESTIGATION FINDINGS:
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On 03/04/2025 at 9:00am, Licensing Program Analyst (LPA), Sarah Garcia and Licensing Program Manager (LPM) Martha Malane conducted an unannounced complaint inspection to deliver the findings for the above allegations. This is a continuation of the investigation initiated on 11/20/2024. The purpose of today’s visit is to deliver the findings of the investigation conducted by the Department’s Investigation Branch (IB). Upon arrival, LPA met with director, Donna Koontz and owner, Alejandro Moreno. Director guided LPA on a walkthrough of the facility and LPA conducted a census. Total census is 91 preschool children and 14 staff.

A review of Facility Report Summary on this date indicated that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Continued on Page 2
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Sarah Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 06-CC-20241119170935
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: GAOWA MONTESSORI SCHOOL
FACILITY NUMBER: 304371438
VISIT DATE: 03/04/2025
NARRATIVE
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Page 2
This is an amended version of the original report generated on 03/04/2025.

The Department received a complaint on 11/19/2024 alleging Methamphetamine and Fentanyl found in baggie in facility restroom. During the course of the investigation, additional allegations regarding conduct inimical and reporting requirements were discovered.

During the course of the investigation, IB investigator interviewed staff, children, reviewed Costa Mesa Police Department (CMPD) report, facility documents and video footage. The investigation concluded that on 11/8/24 Staff 1 (S1) left a lighter in a facility restroom and Staff 3 (S3) found pills and a powdered substance in a baggie in the same restroom. Facility staff members confirmed that staff and parents have access to the restroom where the unknown substance was discovered. Staff stated the substance was found in the restroom on 11/8/24; however, the substance was kept in a locked cabinet located in the front office of the facility until 11/18/24 when owner, Alejandro Moreno turned the baggie over to the CMPD. CMPD tested the contents of the baggie which tested positive for amphetamines and fentanyl.

The Orange County Regional Office received an unusual incident report (LIC 624) on 11/21/2024 from director, Donna Koontz. Director reported that on 11/8/24 a lighter and a baggie with an unknown substance was found in facility restroom.

Based on record review, CMPD report and interviews, there is enough corroboration and preponderance of evidence showing there was an illegal substance in a facility restroom which is accessible to staff and parents, facility did not ensure a safe and healthful environment for the children, and the facility did not report incident in a timely manner. Therefore, the preponderance of evidence standard has been met, therefore the above allegations are found to be Substantiated. Health and Safety Code Section 1596.885(c) Conduct Inimical and California Code of Regulations, Title 22, Division 12, Chapter 1 Sections, 101223(a)(2) Personal Rights and 101212(d) Reporting Requirements are being cited on the attached LIC9099D.


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SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Sarah Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 06-CC-20241119170935
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: GAOWA MONTESSORI SCHOOL
FACILITY NUMBER: 304371438
VISIT DATE: 03/04/2025
NARRATIVE
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Page 3

LPA Sarah Garcia informed owner, Alejandro Moreno that this report dated 03/04/2025 documents (2) Type A citations which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. Also, LPA Sarah Garcia informed owner, Alejandro Moreno to provide a copy of this licensing report dated 03/04/2025 that documents any Type A citation(s) 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. Director will send proof of signed acknowledgment of receipt of licensing reports (LIC 9224).

This report documents (1) Type B is being cited for reporting requirements on the attached LIC 9099D.

Exit interview conducted and report was reviewed with the owner, Alejandro Moreno and director. A notice of site visit was given and must remain posted for 30 days.

End of Report.
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Sarah Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 06-CC-20241119170935
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: GAOWA MONTESSORI SCHOOL
FACILITY NUMBER: 304371438
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
03/05/2025
Section Cited
HSC
1596.885(c)
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1596.885(c): Conduct Inimical
(c) Conduct which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of this state.
This requirement was not met as evidenced by:

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Director will conduct an all staff policy and procedures training. Director will submit agenda and staff declarations to LPA by 5pm on 03/05/2025.
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Based on interviews and record review, amphetamines and Fentanyl were discovered in facility restroom accessed by staff and parents which poses an immediate risk to the health of the children in care.
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Request Denied
Type A
03/05/2025
Section Cited
CCR
101223(a)(2)
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101223 (a)(2) Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.This requirement was not met as evidenced by:
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Director will conduct an all staff policy and procedures training. Director will submit agenda and staff declarations to LPA by 5pm on 03/05/2025.
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Based on interviews, the licensee did not ensure the children were provided a safe environment due to amphetamines and Fentanyl discovered in facility restroom accessed by staff and parents which poses an immediate risk to the personal rights of 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.
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Sarah Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 06-CC-20241119170935
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: GAOWA MONTESSORI SCHOOL
FACILITY NUMBER: 304371438
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
03/11/2025
Section Cited
CCR
101212(d)
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CCR 101212(d) Reporting Requirements
...During the operation of the childcare center... a report shall be made to the Department by... next working day...In addition, a written report containing the information specified...
This requirement was not met as evidenced by:

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Facility management agreed to watch a video on reporting requirements. Director agreed to sign declarations stating what they have learned and send to LPA email by 5pm on 03/11/2025. Child Care Reporting Requirements- California Child Care Licensing- ccld.childcarevideos.org.
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Based on interviews and record review, the facility did not report 11/8/24 incident to the Department in a timely manner. This is a potential health and safety risk 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.
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Sarah Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5