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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494644
Report Date: 03/23/2021
Date Signed: 03/29/2021 05:35:57 PM

Document Has Been Signed on 03/29/2021 05:35 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:WOODLAKE MONTESSORI - INFANT CENTERFACILITY NUMBER:
197494644
ADMINISTRATOR:HORDAGODA, NOESHFACILITY TYPE:
830
ADDRESS:23363 BURBANK BLVDTELEPHONE:
(323) 767-4517
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY: 30TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
03/23/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Noesh Hordagoda/DirectorTIME COMPLETED:
02:05 PM
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Licensing Program Analyst (LPA) Silva Garibyan met with director to conduct a pre-licensing inspection. The applicants submitted application for 16 infants and 14 toddlers. Applicant provided a tour of the facility at 12:00 P.M.. The fire department has granted the fire clearance for the capacity of 30 children. Fire Clearance granted on 10/13/20 by Inspector Cindy Struck, LA City Fire Department. The infant center is located inside of Woodland Hills Church of Christ Church. Control of property was verified with a copy of the Commercial Lease Agreement.
LPA toured the facility inside and outside.
The following are the measurements:

Infant Indoor: 12 x 40 = 480 sq. ft/35 = 13 infants

The crib area was in the infant classroom which wasn't included in measurements.

Infant Outdoor: 13 x 78 = 1,014 sq. ft/75 = 13 infants

Toddler Indoor: 16.9 x 25.5 = 430.95 sq. ft./35 = 12 toddlers

Toddler Outdoor: 22 x 41 = 902 sq.ft /75 = 12 toddlers


The outdoor space is completely fenced in and there are no bodies of water. There is a shaded area ( covered by a canopy) for the infants children.
Continued
SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE: DATE: 03/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/29/2021
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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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: WOODLAKE MONTESSORI - INFANT CENTER
FACILITY NUMBER: 197494644
VISIT DATE: 03/23/2021
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The infant yard will be enclosed by fences to restrict the areas to Infant use only. The yards contain infant age appropriate play equipment.
The crib area contains 6 cribs. The infant classroom contains 2 changing tables within arms reach of a sink. The toddler clawswsroom contains one changing table within arms reach of a portable sinkg. There is a refrigerator for Infant milk and meal storage. Crib bedding will be washed by the center daily. Labels will identify each child's crib.
Parents will provide lunch, baby food or milk for infants enrolled in this program. Also facility provides AM and PM snacks, for older infants. Medications will be stored in a medication box in the kitchen. First aid supplies are available in infant classroom. Sign in/out procedures will be implemented at the entrance of the facility. The classroom will have a list of infants signed in for the day. There is water readily available in infant classroom.
Director understands that Infant/ToddlerTeachers must have Infant/Toddler units. Minimum staffing ratios are 1 teacher to every 4 infants. 1 teacher and 1 aide may supervise up to 8 infants. Applicant is also aware of Infants Needs and Services Plans and the requirement to conduct meetings as needed with infant families to update the Needs and Services Plans. Logs will be kept in the classroom for staff to document Infant feedings and diaper changes.
Furniture/Equipment/Toys/Books
There are plenty of toys and material for children in care to utilize.

Napping Area/Equipment

The program will be open from 6:00am to 6:00pm. The center has appropriate napping equipment.
Continues
SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2021
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: WOODLAKE MONTESSORI - INFANT CENTER
FACILITY NUMBER: 197494644
VISIT DATE: 03/23/2021
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Medication
Medication if administered is to be properly labeled and stored in the original container. Director advised that children should be screened every morning for illness and unusual marks. First Aid supplies are stored in the classrooms.

Sign In/Out
Director is to ensure that parents sign in and out daily using their full and legal signature.

Safe Sleep Links:
AAP: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative

Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

Safe sleep for your baby pamphlet and what does safe sleep look like wall flyer provided to applicant. Safe Sleep new flyer (5/23/2019) also given to applicant.



SIDS & SHAKEN BABY SYNDROME INFORMATION: LPA discussed safe sleep for infants with applicant: Infants must be placed on their backs and must be physically checked every 15 minutes to gauge temperature and ensure they are breathing. Applicant reviewed both items provided and understands the guidance of safe sleep practices. LPA discussed flyer given today (Never Shake a Baby) Applicant reviewed flyer and understands the preventive practices of shaken baby syndrome and abusive head trauma.

Continued
SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2021
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: WOODLAKE MONTESSORI - INFANT CENTER
FACILITY NUMBER: 197494644
VISIT DATE: 03/23/2021
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The following was discussed during this inspection:
  • Licensee/Applicant was made aware that state law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.
  • Licensee/Applicant was advised that regulation prohibits the smoking of tobacco in a private residence licensed as a family childcare home during the hours of operation.
  • Licensee/Applicant was reminded that all infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome), and to never shake a baby to prevent the Shaken Baby Syndrome.
  • Applicant was also reminded that only children eating may be in highchairs and that car seats are utilized only for transportation.
  • The "Notification of Parent's Rights" (PUB394) was discussed with the licensee and the licensee was advised that it must be posted in an area of the home accessible to parents.
  • Licensee/Applicant was made aware of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects to disseminate information on the State’s licensing role, provide information to the public and parents on childcare licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541; Email Address: childcareadvocatesprogram@dss.ca.gov
  • Also, discussed was; Commencing September 1, 2016, SB 792, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles. Exemption were also discussed
  • Beginning on January 1, 2018, AB 1207, requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: www.mandatedreporterca.com
  • Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2021
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: WOODLAKE MONTESSORI - INFANT CENTER
FACILITY NUMBER: 197494644
VISIT DATE: 03/23/2021
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Based on todays observations the facility shall be recommended for licensure with a capacity of 13 infants and 12 toddlers determined by the facility's indoor activity space.

Applicant was informed that the following is pending licensure and needs to be corrected within 30 days from the date of this report


  • Director's current CPR/First Aid Certificate
  • Director's Lead Poisoning Certificate
  • Photo of vent covered in infant room

A copy of this report will be electronically mailed to the applicant for review and signature

A read receipt shall confirm as receipt of the electronically delivered report.

Applicant shall print and sign the report and mail the report to the licensing office, with an original signature.

If there are any questions or concerns, please contact the department at (424) 301-3077

SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2021
LIC809 (FAS) - (06/04)
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