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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418410
Report Date: 05/09/2023
Date Signed: 05/09/2023 10:49:42 AM

Document Has Been Signed on 05/09/2023 10:49 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:HILL POINT MONTESSORI PREPATORY SCHOOLFACILITY NUMBER:
197418410
ADMINISTRATOR:TAMPUS, MARIAFACILITY TYPE:
850
ADDRESS:6601 VALLEY CIRCLE BOULEVARDTELEPHONE:
(818) 884-8261
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY: 57TOTAL ENROLLED CHILDREN: 41CENSUS: 37DATE:
05/09/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Dayani Nawagamuwage- AdministratorTIME COMPLETED:
11:08 AM
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On 05/09/2023, Licensing Program Analyst (LPA) Suzette Ornelas arrived at facility to conduct an unannounced case management – incident visit and met with Facility Representative Dayani Nawagamuwage.

On 04/20/2023 the facility self reported an unusual incident. Unusual Incident – On 04/20/2023, a child was being dropped off by the mother. As mother was walking to the classroom to sign child in, child stopped to see a cage with 2 rabbits which is located outside the elementary classroom (9). Child put her finger in the cage and a rabbit bit off the tip of the child’s ring finger on her right hand. When the child was bitten she started to cry and Elementary teacher went to her aid and provided a bandage. Dayani/administrator was called out of a meeting and was able to provide support. Front office manager called 911 soon after the bite. The ambulance arrived in 5 minutes. Paramedics arrived, provided aid to the child and transported child with mother to the Hospital.

LPA toured the facility and observed 37 children in care and under supervision of 6 staff.

LPA collected a copy of the video footage via email, Facility sketch, Client/child file for Child 1 (C1), Staff work schedule, Client roster with contact information, Sign-in/out sheet for 04/20/23 and the plan of correction on 05/09/2023.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the facility representative Dayani Nawagamuwage.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2023
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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