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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419681
Report Date: 12/13/2022
Date Signed: 12/13/2022 02:21:54 PM

Document Has Been Signed on 12/13/2022 02:21 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:PALOS VERDES MONTESSORI ACADEMYFACILITY NUMBER:
197419681
ADMINISTRATOR:OFELIA WATANABEFACILITY TYPE:
850
ADDRESS:28451 INDIAN PEAK ROADTELEPHONE:
(310) 541-2405
CITY:RANCHOS PALOS VERDESSTATE: CAZIP CODE:
90274
CAPACITY: 98TOTAL ENROLLED CHILDREN: 98CENSUS: 66DATE:
12/13/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Eliza Byrd, DirectorTIME COMPLETED:
02:40 PM
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On 12/13/2022 @ 1:45 PM, Licensing Program Analyst (LPA) Miriam Cohen conducted an
unannounced case management visit for the assessment of a Civil Penalty against a complaint that was substantiated on 12/07/2022.

Upon arrival, LPA Cohen observed 10 adults providing care for 66 children.
LPA Cohen met with preschool director, Eliza Byrd.

The facility was cited a Type A deficiency according to California Code of Regulations Title 22) and a Civil Penalty was assessed for $500.00 (See LIC 9099D report for deficiencies)
A plan of correction was discussed and provided to the director. Appeal Rights were provided. Exit interview conducted and discussed and explained with director.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Miriam Cohen
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2022
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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