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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371605
Report Date: 07/09/2024
Date Signed: 07/09/2024 04:16:29 PM

Document Has Been Signed on 07/09/2024 04:16 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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:CHILDREN'S MONTESSORI CENTER OF YORBA LINDAFACILITY NUMBER:
304371605
ADMINISTRATOR/
DIRECTOR:
KEMPS, DISHNIFACILITY TYPE:
830
ADDRESS:17550 YORBA LINDA BLVD.TELEPHONE:
(714) 528-0831
CITY:YORBA LINDASTATE: CAZIP CODE:
92886
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 7DATE:
07/09/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:31 AM
MET WITH:Office Administrator Binbin "Vicky" ZhaoTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
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On 7/9/2024, at 11:30am Licensing Program Analyst (LPA), Anna Chan conducted an unannounced Case Management visit. Upon arrival, LPA met with Office Administrator Binbin "Vicky" Zhao and informed the admin of the purpose of the visit. LPA was led on a walk-through of the facility by the admin and census was taken. LPA observed 7 infant children and 2 teachers.

On 7/9/24, during records review, LPA discovered form LIC9224 dated 06/21/24 was missing in 5 infant files.

On 7/9/24, LPA interviewed the administrator, the administrator stated the facility notified the parents of the Type A violation dated 06/21/24, but did not get any signed copies of LIC9224 back to the facility. Admin Zhao stated the facility will ask for signed copy of LIC9224 from parents. LPA provided a consultation of Health and Safety Code 1596.8595.(c)

The facility was reminded to provide a copy of the report dated 06/21/24 by the next business day or the next day the child is in care to the parents/guardians of children currently enrolled and newly enrolled.

Exit interview was conducted with administrator Binbin Zhao. Notice of Site Visit was posted during the visit. 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. Director was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above.

End of Report
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE: DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2024
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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