197420015-2-2-2022-30-CC-DLOE-CBA38X-20220202170215

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197420015
Report Date: 02/02/2022
Date Signed: 02/02/2022 05:02:26 PM

Document Has Been Signed on 02/02/2022 05:02 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:	MONTESSORI WOODLAND HILLS		FACILITY NUMBER:	197420015
ADMINISTRATOR:	ZOHRA BAREKZAI		FACILITY TYPE:	850
ADDRESS:	6104 FALLBROOK AVENUE		TELEPHONE:	(818) 340-4404
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91367
CAPACITY: 54	TOTAL ENROLLED CHILDREN: 17	CENSUS: 17	DATE:	02/02/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Luana Madarigal, Regional Director		TIME COMPLETED:	05:00 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

On 02/02/2022 at 8:30 a.m. Licensing Program Analyst (LPA) Deborah Lowe, conducted an unannounced Annual Required Inspection for the preschool license. LPA met with Regional Director, Luana Madarigal, and toured the facility indoors and outdoors. Regular Days and hours of operation are Monday – Friday 6:30 a.m. – 6:00 p.m. Due to COVID facility stated temporary hours of operation are Monday – Friday 7:30 a.m. – 5:30 p.m.

There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible. No poisons were observed during the inspection.

Furniture and equipment are in good condition, free of sharp, loose or pointed parts. LPA Lowe observed one piece of wooden furniture with a broken piece. Facility removed from classroom during visit. Playground equipment is in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All toilets and handwashing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe.

All food preparation and storage areas are clean, free of litter/rubbish and free of rodents/vermin. Facility was not observed with a full-service kitchen. Facility provides snacks and children bring their own food from home. All food is protected against contamination and any contaminated food is discarded immediately. Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is available use of a water cooler system observed in the classrooms.

Areas around high climbing equipment, swings and slides have cushioning material to absorb falls. The facility is free of flies, insects and rodents. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements, LPA was able to hear a successful test.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022

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 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MONTESSORI WOODLAND HILLS	FACILITY NUMBER: 197420015
	VISIT DATE: 02/02/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Capacity and limitations as specified on the license are being maintained. At least one person trained in CPR and Pediatric First Aid is present when children are at the facility or at offsite activities. The person who signs the child in/out of the facility shall use their full legal signature and record the time of day. LPA observed one classroom with 12 children being supervised by 1 fully qualified teacher and 1 assistant. At 9:05 a.m. during facility tour LPA Lowe observed a staff member in room #3 supervising 5 children. LPA Lowe’s review of staff files shows staff member in room #3 supervising 5 children without transcripts to verify teaching qualifications.

LPA reviewed a sample of children’s files and observed files were complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child and medical assessment.

LPA reviewed staff files of staff observed present during visit and observed files were complete with immunization records for influenza, pertussis, measles, and completion of mandated reporter trainings. One staff file was observed in need of a health screening. Menus are posted at least one week in advance where an authorized representative can view them.

Incidental Medical Services (IMS) are currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

The following items were discussed:

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Regional Director, Luana Madarigal was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022

LIC809 (FAS) - (06/04)

Page: 5 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MONTESSORI WOODLAND HILLS	FACILITY NUMBER: 197420015
	VISIT DATE: 02/02/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with Regional Director, Luana Madarigal 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 Regional Director, Luana Madarigal 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.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D)

Licensee was provided a copy of their appeal rights.

LPA Deborah Lowe informed Regional Director, Luana Madarigal that this report dated 02/02/2022 documents one Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Deborah Lowe informed the Regional Director, Luana Madarigal to provide a copy of this licensing report dated 02/02/2022 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

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 Regional Director, Luana Madarigal.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022

LIC809 (FAS) - (06/04)

Page: 2 of 6

Document Has Been Signed on 02/02/2022 05:02 PM - It Cannot Be Edited

Created By: Deborah Lowe On 02/02/2022 at 04:42 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MONTESSORI WOODLAND HILLS	FACILITY NUMBER: 197420015
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/02/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

101216.3(a)

Teacher-Child Ratio

(a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance, except as specified in (b) and (c) below. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above in LPA observed S#2 supervising 5 children, LPA file review showed S#2 file without transcripts to verify teacher qualifications which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 02/09/2022
	Plan of Correction
1 2 3 4	On 2/02/2022 Regional Director removed S#2 from classroom. Regional Director provided LPA a declaration stating understanding of Regulation 101216.3(a) and stating staff will not be left alone to supervise children until transcripts have been reviewed by LPA. On or before 02/09/2022 Regional Director will email LPA Lowe completed transcripts for S#2.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Karren Starks

LICENSING EVALUATOR NAME:

Deborah Lowe

LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022

LIC809 (FAS) - (06/04)

Page: 4 of 6