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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191224296
Report Date: 01/18/2023
Date Signed: 01/18/2023 02:40:54 PM

Document Has Been Signed on 01/18/2023 02:40 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:PARK MONTESSORI CHILDREN'S CTR.FACILITY NUMBER:
191224296
ADMINISTRATOR:PARK, GRACEFACILITY TYPE:
850
ADDRESS:13130 HERRICK AVE.TELEPHONE:
(818) 367-5483
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY: 75TOTAL ENROLLED CHILDREN: 75CENSUS: 23DATE:
01/18/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Minju KyongTIME COMPLETED:
02:55 PM
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On 01/18/22 Licensing Program Analyst (LPA) Justin Dorsey met with Teacher Minju Kyong to conduct an unannounced case management inspection. The purpose of the case management inspection was to access a civil penalty from a visit on 10/20/22. Upon arrival, LPA observed 23 children in care with 3 staff members.

During the visit LPA Dorsey toured the center and assessed a civil penalty for a visit on 10/20/22.

A notice of site visit was given and must remain posted for 30 days.

An exit interview was conducted, during which this report and the Appeal Rights were discussed with Teacher Minju Kyong.


SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2023
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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