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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371438
Report Date: 08/13/2026
Date Signed: 08/13/2026 11:24:27 AM

Document Has Been Signed on 08/13/2026 11:24 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:		BERGMAN, JULIEFACILITY TYPE:
850
ADDRESS:1620 ADAMS AVENUETELEPHONE:
(714) 714-0055
CITY:COSTA MESASTATE: CAZIP CODE:
92626
CAPACITY: 120TOTAL ENROLLED CHILDREN: 109CENSUS: 76DATE:
08/13/2026
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:35 AM
MET WITH:Licensee, Alejandro Moreno and Director, Julie BergmanTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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On 8/13/2026, Licensing Program Analyst (LPA) Sarah Garcia conducted an unannounced Case Management Licensee initiated inspection for adding a room and increasing capacity for Toddler component while decreasing the Preschool capacity. LPA met with Licensee, Alejandro Moreno and director, Julie Bergman who gave a tour of the facility including the new toddler room. LPA took census and observed 76 preschool children (including 28 toddlers).

Facility is currently licensed for 120 children. (84 preschool children ages (2.5 years to 6 years old) in the five rooms and 24 toddlers (18-36 months) in three assigned rooms. Facility is now seeking to change a preschool room to a toddler room with an increase in capacity to 48 toddlers and decreasing the Preschool capacity to 72 preschool age children. Facility shall remove Preschool Room # 3 (Neptune room) but shall continue to use Room # 1(Venus) Room # 2 (Pluto), Room # 4 (Mars), Room # 8 (Earth) for the requested 72 preschool age children including the three Piano rooms.

LPA inspected and measured the new Toddler room, Room #3 (Neptune). Classrooms are adequately equipped with age and size appropriate furniture and equipment. Drinking water in the indoor activity space is provided by sports bottles with the children's name on it. Sign in/Sign out procedure was reviewed and meets regulation requirements. The facility utilized the “ProCare” app to sign in/out children. There is a working smoke detector, carbon monoxide detector, and fire extinguisher 3A40BC that meet statutory requirements. Fire department has given the required approval. Cubbies are available for storage of individual child’s personal belongings and/or bedding.

Continued on Page 2

Tina Nguyen
Sarah Garcia
DATE: 08/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2026
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 4
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: GAOWA MONTESSORI SCHOOL
FACILITY NUMBER: 304371438
VISIT DATE: 08/13/2026
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Children nap on cots, and bedding is stored individually and is taken home weekly to be washed by parents or facility washes blankets at end of week. Facility provides snacks throughout the day, while lunch can be brought from home or purchased and distributed preschool staff and stored in their individual storage in their cubbies.

Based on today's measurements and the 12/04/2020 licensing report the following Indoor Measurements for three (3) Toddler rooms are:

Room #3 (Neptune): 19’42” X 21’92” = 425'’69” / 35 = 12.16 (12 toddlers)

Room # 5 (Saturn): 19’33” X 22’67” =438’21 / 35 = 12.52 (12 toddlers)

Room # 6 (Mercury): 21’92” X 19’42” = 425’69 / 35 = 12.16 (12 toddlers)

Room # 7 (Jupiter): 37’17” x 19’42” = 721’84 / 35 = 20.62 (21 toddlers)

Total toddler Indoor capacity: 2,011’43” divided by 35 = 57.46 (57 Toddlers): Capacity requested is 48.

Based on the 12/04/2020 licensing report the following Indoor Measurements for Preschool rooms:

Room #1 (Venus): 44’33” X 22’08” = 978’81”

Room #2 (Pluto): 34’50” X 12’92” = 445’74”

Room #4 (Mars): 36’ X 22’67 = 816’12”

Room #8 (Earth): 65’42”X29’42” =1924’66

Piano Room # 1: 10’5” x 7’17” =75’29”

Piano Room # 2: 10’5” x 6’83” = 71’72”

Piano Room # 3: 10’5” X 7’17” = 75’29”

Total preschool indoor capacity: 4,387’63 divided by 35 = 125.36 (125 children): Capacity requested 72. Continued on Page 3

NAME OF LICENSING PROGRAM MANAGER: Tina Nguyen
NAME OF LICENSING PROGRAM ANALYST: Sarah Garcia
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2026
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: GAOWA MONTESSORI SCHOOL
FACILITY NUMBER: 304371438
VISIT DATE: 08/13/2026
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Total Toilets and sinks Sinks: 18 X 15 = 270 (children) / Toilets: 10 + 1 urinal X 15 = 165 (children)

LPA inspected the outdoor activity space. Climbing structures are age appropriate for Toddlers as well as Preschool age children. The surface of the outdoor activity space was well maintained and free of hazards. The cushioning material around the climbing equipment, slides and other similar equipment appeared to be enough to absorbs falls. Drinking water in the outdoor activity space is provided by sports bottles with the child’s name on it. The outdoor equipment was in good repair and free of sharp edges. There are no bodies of water present at the facility. The facility grounds were safe, sanitary and in good repair.

Based on the 12/04/2020 licensing report the following Outdoor Measurements are:

Front yard: 110 X 76 = 8360

Side planter yard: 103 x 15’83” = 1630.49

Total Outdoor space: 9990.49 divided by 75 = 133.21 (133 children)

The facility was granted waiver for a shared playground with toddler children on rotating schedules.

Based on Indoor, Outdoor measurements, and Sink and Toilet availability, facility has enough space to accommodate the requested capacity of 48 toddlers (18 – 36 months) in Rooms Neptune, Saturn, Mercury and Jupiter and 72 Preschool age children, in the assigned rooms (Venus/ Pluto/ Mars / Earth and Three Piano Rooms) Monday to Friday 7:00AM to 5:30 PM. (Total capacity = 120 children)

Fire clearance was received on 7/29/2026 from City of Costa Mesa Fire Department approving the requested capacity.

In the areas that were evaluated, no deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit.

File will be submitted to management for final review. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the director, Julie Bergman.

End of Report.

NAME OF LICENSING PROGRAM MANAGER: Tina Nguyen
NAME OF LICENSING PROGRAM ANALYST: Sarah Garcia
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2026
LIC809 (FAS) - (06/04)
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