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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371720
Report Date: 11/22/2024
Date Signed: 11/22/2024 12:52:50 PM

Document Has Been Signed on 11/22/2024 12:52 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:MONTESSORI OF BREAFACILITY NUMBER:
304371720
ADMINISTRATOR/
DIRECTOR:
HATHOTUWEGAMA, N.FACILITY TYPE:
860
ADDRESS:701 MULBERRY AVENUETELEPHONE:
(914) 329-1556
CITY:BREASTATE: CAZIP CODE:
92821
CAPACITY: 63TOTAL ENROLLED CHILDREN: 63CENSUS: 59DATE:
11/22/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Applicant Nadhira HathouwegamaTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On 11/22/2024 at 10:00am, Licensing Program Analyst (LPA), Romy Castanon conducted an announced Pre-Licensing inspection for a change of ownership. Upon arrival, LPA met with Applicant Nadhira Hathotuwegama. Administrator Nasreen Ali was also present during today’s inspection. Applicant is requesting to be licensed for 63 preschoolers ages 2-6 years old in Primary Classroom #1, Primary Classroom #2, and EDC (Extended Day Care) Room that is used as a multipurpose room. Hours of operation will be Monday-Friday 7:00am-6:00pm.

All indoor and outdoor activity space utilized for the children was inspected today. LPA informed Applicant Nadhira that staff are required to maintain direct visual supervision of the children at all times during indoor and outdoor activities. When medications are on site, Applicant Nadhira stated that they will be in a higher cabinet located in each classroom. A fully equipped first aid kit is located in a bag near the entrance of each classroom. There is an operational carbon monoxide detector on site. LPA tested the carbon monoxide detector located in the EDC room. All required licensing documents were observed posted in the EDC room. Children will be signed in and out near the office entrance.

LPA continued to tour the facility and measured all indoor and outdoor activity space. Total indoor activity space measured 2,217.79 square feet, which is sufficient to accommodate the requested capacity of 63 children. LPA observed all indoor activity space to be complete with safe, age-appropriate furniture and equipment, including tables, chairs, cubbies, napping cots/mats, bookshelves, and other activity supplies for the children. Drinking water is available in the classrooms via filtered water pitcher and children’s water bottles. LPA observed all hazardous items to be inaccessible to children. There are no bodies of water or weapons on the property. Fire clearance was granted on 11/21/2024.

LPA observed a total of 8 sinks and 6 toilets available for children’s use. These are sufficient to accommodate the requested capacity of 63 children. There is a separate staff restroom equipped with a toilet and a sink. The isolation area for children who are ill will be the office and office restroom. (Continue to page 2)

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Romelia M Castanon
LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2024
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: MONTESSORI OF BREA
FACILITY NUMBER: 304371720
VISIT DATE: 11/22/2024
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Facility will provide morning snacks and families provide lunch with afternoon snack. The facility will does not prepare food on site. All morning snacks are prepackaged or premade and delivered to each classroom.

The facility currently has a fully fenced playground area. Chain link fencing is at least four feet high. The total square footage for all the outdoor activity space is 10,288 square feet which is sufficient to accommodate the requested capacity. Shade is provided via 3 large canopies, building overhang and tress. There are sufficient outdoor age-appropriate toys and play equipment available on the playground. There is a climbing structure on the playground for children. Applicant Nadhira stated it is age appropriate for children ages 2-6 years old and is properly anchored. There is adequate cushioning in fall zones of climber provided by artificial turf. Drinking water is available via filtered water jug and children’s water bottles. LPA observed all hazardous items on the playground to be inaccessible to children. Applicant Nadhira was reminded that any changes to the facility must be reported to and approved by Community Care Licensing.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP).



Applicant Nadhira 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, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.”

This facility plans to provide 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) or (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.


LPA reviewed with Applicant Nadhira the LIC 311A, Records to Be Maintained at The Facility, for child’s records, personnel records, administrative records, and documents to be posted. (Continue to page 3)
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Romelia M Castanon
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2024
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: MONTESSORI OF BREA
FACILITY NUMBER: 304371720
VISIT DATE: 11/22/2024
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LPA discussed the safe sleep regulations with Applicant Nadhira and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep, as an additional resource. LPA also informed [applicant, licensee, or facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/, and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Applicant Nadhira was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.



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 platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

The following corrections are needed prior to the issuance of the license:
1. A full review of application packet and any corrections requested by LPA.
2. Typo corrections on 850STD form by department and local fire authority.

Applicant Nadhira understands that all proof of corrections must be provided to the Department within 30 days, or the application may be denied.

Exit interview conducted and report was reviewed with Applicant Nadhira Hathotuwegama.

End of Report

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Romelia M Castanon
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2024
LIC809 (FAS) - (06/04)
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