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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371442
Report Date: 05/10/2023
Date Signed: 05/10/2023 01:14:55 PM

Document Has Been Signed on 05/10/2023 01:14 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:ACACIA MONTESSORI SCHOOLFACILITY NUMBER:
304371442
ADMINISTRATOR:CHUNG, SUNFACILITY TYPE:
830
ADDRESS:1701 EAST CHAPMAN AVENUETELEPHONE:
(336) 870-2176
CITY:FULLERTONSTATE: CAZIP CODE:
92831
CAPACITY: 13TOTAL ENROLLED CHILDREN: 13CENSUS: 13DATE:
05/10/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:46 PM
MET WITH:Owner/DirectorTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek conducted a case management inspection of the facility for the purpose of decreasing the capacity of preschool to add a Toddler Option Component to the Infant license and increase the capacity of infant license. LPA met with director/owner Sun (Estella) Chung who gave LPA a tour of the classrooms. Census was taken. There were a total of 13 preschool children in Room # 3 with three staff. No infants napping in the crib area. LPA reminded the director that a staff needs to be in the crib area to supervise children while napping. (one staff to 12 napping children).
A review of the Facility Personnel Report Summary on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
The facility has requested to provide care and supervision to 13 infants from infant license, 32 toddlers from Toddler Option Program and 22 preschool children. LPA discussed the Toddler Option Program with the director and the availability of the space, restrooms, and playground. After a final discussion with the director. she stated she intended to increase the capacity of the infant license to separate the older group in an extension space from the preschool rooms. She said she was undecided at this time to request for Toddler Option Program. LPA and director reviewed the application (LIC 200A) for future submission. The director discussed the number of children adding to the infant license and the number of children taking off from her preschool license. The preschool rooms are designated to room # 1 and 2. The director is planning to divide room # 2 physically for preschool and older infant to increase the infant license. The fire clearance approval that we have received is for adding toddler option to the infant license and that did not meet the facility's needs. The fire department had approved for the capacity of 13 infants in the infant room (Room # 3). The director decided to withdraw her application at this time and apply again in the future with the changes that meets the facility's needs.
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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE: DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/10/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: ACACIA MONTESSORI SCHOOL
FACILITY NUMBER: 304371442
VISIT DATE: 05/10/2023
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The Director, Sun (Estella) Chung was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
The director was reminded of safe sleep regulations and logging every 15 minutes check on infants and toddlers under 24 months old. A sample of the log was given. The director was reminded that it applies to children under 24 months old. The director is current with CPR and Mandated Reporter Training.

Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Exit interview conducted and report was reviewed with the director, Sun (Estella) Chung .

The director stated she would change the current patrician to a new patrician for the crib area. LPA gave the measurements of the crib area and activity area measured in 2/1/2021.


Room # 3:
568.87 - 114.08 (Encumbered- napping area) = 454.79 = 12.99 ( 13 infants)
A withdrawal letter was submitted to LPA on this date. The director will decide to revise the application for the correct number of children and getting approval from fire department.

End of report

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

DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023
LIC809 (FAS) - (06/04)
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