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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371438
Report Date: 03/06/2025
Date Signed: 03/06/2025 09:57:37 AM

Document Has Been Signed on 03/06/2025 09:57 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:GAOWA MONTESSORI SCHOOLFACILITY NUMBER:
304371438
ADMINISTRATOR/
DIRECTOR:		MINGOLLA, TANYAFACILITY TYPE:
850
ADDRESS:1620 ADAMS AVENUETELEPHONE:
(714) 714-0055
CITY:COSTA MESASTATE: CAZIP CODE:
92626
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 96DATE:
03/06/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Director, Donna KoontzTIME VISIT/
INSPECTION COMPLETED:
10:15 AM
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On 03/06/2025 at 9:10am Licensing Program Analyst (LPA) Sarah Garcia and Licensing Program Manager (LPM) Martha Malane conducted an unannounced Case Management-other visit to provide the facility a copy of an Amended Complaint Report. LPA met with director, Donna Koontz and owner, Alejandro Moreno and informed director about the purpose of the visit. Director guided LPA on a walk through of the facility and LPA conducted a census. Total census is 96 preschool children and 15 staff.

A review of staff criminal clearance records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During the visit, LPA reviewed the Amended Report with the director, Donna Koontz and owner, Alejandro Moreno who acknowledged and signed the Amended Report.

An exit interview was completed. The report was reviewed and discussed with director, Donna Koontz and owner, Alejandro Moreno. Director was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. Failure to post will result in Civil Penalties of $100.00.

SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Sarah Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2025
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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