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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371545
Report Date: 06/09/2023
Date Signed: 06/09/2023 03:17:16 PM

Document Has Been Signed on 06/09/2023 03:17 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:DANA MONTESSORI SCHOOLFACILITY NUMBER:
304371545
ADMINISTRATOR:GOVINDASWAMY, M.FACILITY TYPE:
850
ADDRESS:34052 ST.OF THE VIOLET LANTERNTELEPHONE:
(949) 240-7271
CITY:DANA POINTSTATE: CAZIP CODE:
92629
CAPACITY: 34TOTAL ENROLLED CHILDREN: 34CENSUS: 15DATE:
06/09/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Director, Govindaswamy, M. TIME COMPLETED:
03:30 PM
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On 06/09/2023, Licensing Program Analyst (LPA) Aiddee Nunez conducted a Case Management due to deficiencies observed during today's inspection. LPA toured the facility and census was taken. Census was taken and LPA observed a total of 1 toddler child, 14 preschool children, and 2 staff members.

A review of staff criminal clearance records 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.

During the facility tour, at 9:17 AM, LPA Nunez observed 1 toddler and 14 preschool children commingling in the outside play yard with 2 staff members present. LPA asked Director if she can view the Toddler’s child (C1) file and the director stated that she did not have a file for C1. Director confirmed and stated that C1 was under 24 months old. At approximately 9:20 AM C1 Parent (P1) came to pick up C1 and P1 told the LPA that the Director had called P1 to pick up C1.

Based on LPA’s observation and interview with the director, the facility is being cited in accordance with California Code of Regulations, Title 22, Division 12, Section 101161 (a) Limitations on Capacity and Ambulatory Status and 101221 (a) Child’s Record. See attached LIC 809D.

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 Govindaswamy M.

End of Report

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Aiddee Nunez
LICENSING EVALUATOR SIGNATURE: DATE: 06/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/09/2023
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 06/09/2023 03:17 PM - It Cannot Be Edited


Created By: Aiddee Nunez On 06/09/2023 at 02:08 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: DANA MONTESSORI SCHOOL
FACILITY NUMBER: 304371545

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/09/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/20/2023
Section Cited
CCR
101161(a)

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101161 Limitations on Capacity and Ambulatory Status (a) A licensee shall not operate a childcare center beyond the conditions and limitations specified on the license, including the capacity limitation.This requirement is not met as evidenced by:
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C1 was picked up by parent approximately at 9:20 AM.Director stated they will make sure that toddler's and preschool children do not commingle. Director stated that she will not accept any children under 24 months old unless she has enough staff. Director will submit a written plan of correction by 6/20/23.
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Based on observation, children's records, and interview with the director, C1 that is under 24 months old was commingling in the outside play yard with children that are 2 years and older; this poses a potential risk to the health and safety of children in care.
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Type B
06/20/2023
Section Cited
CCR101221(a)

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101221 Child's Records(a) A separate, complete and current record for each child is maintained in the child care center.This requirement is not met as evidenced by:
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Director will maintain a complete file for any child enrolled in care. Director will submit a written plan of correction by 6/20/23.
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Based on observation, children's records, and interview with the director. Director stated that she does not have a record file for C1; which poses/posed a potential health, safety or personal rights risk to persons 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:Thuy Ho
LICENSING EVALUATOR NAME:Aiddee Nunez
LICENSING EVALUATOR SIGNATURE:
DATE: 06/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/09/2023


LIC809 (FAS) - (06/04)
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