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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494947
Report Date: 12/30/2021
Date Signed: 03/21/2024 05:45:53 PM

Document Has Been Signed on 03/21/2024 05:45 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:A - LIST MONTESSORI PRESCHOOLFACILITY NUMBER:
197494947
ADMINISTRATOR:DIVINA RODRIGUEZFACILITY TYPE:
850
ADDRESS:11601 WASHINGTON PLACETELEPHONE:
(424) 500-2288
CITY:LOS ANGELESSTATE: CAZIP CODE:
90066
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: DATE:
12/30/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:34 AM
MET WITH:Byanka PaclebTIME COMPLETED:
01:50 PM
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On 12/30/2021 at Licensing Program Analyst (LPA) Chandler made an announced visit to A – list Montessori Preschool for the purpose of conducting a pre-licensing inspection. LPA met with Byanka Pacleb (applicant) and Mariano Pacleb who provided a tour of the facility. The applicant is requesting a license with a capacity for 30 pre-school children ages 2 – entry into first grade. The facility is a single story, open floor plan classroom building. There is an approved fire clearance on file conducted by Herbert Reddick of the LA City Fire Department

The following was observed of the:

INDOOR ACTIVITY SPACE

Fire extinguishers were 2AB10C or larger.

Carbon monoxide detectors were observed in

First aid kits were available with the required essentials: scissors, bandages, tweezers, and thermometer

SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE: DATE: 12/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/30/2021
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 5
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: A - LIST MONTESSORI PRESCHOOL
FACILITY NUMBER: 197494947
VISIT DATE: 12/30/2021
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Age appropriate toys and equipment were observed in good repair

Drinking water will be provided through filtered water

Heating and Cooling was provided by a central heating system.

Windows were in good repair free of chipping paint, dirt, insects or debris

Adequate lighting was observed

The classroom was clean in good repair

Storage for children’s belongings were observed

Trash cans used for solid waste were observed with tight fitting lids

No Fireplaces or open face heaters were observed

Disinfectants and cleaning solution and other toxins or poisons were made inaccessible to children, placed in locked cabinet or storage room

The office and the staff restroom will be used for isolation of ill children

The classroom was equipped with a working telephone

Parents and authorized adult will sign in using their original.

SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2021
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: A - LIST MONTESSORI PRESCHOOL
FACILITY NUMBER: 197494947
VISIT DATE: 12/30/2021
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The required postings were also posted in this common area.

Children will use mats for napping, Mats were observed in good condition.

Measurements for the indoor activity space was 656.87 divided by 35 SQ. FT. per child = 18 children

FOOD SERVICE:

Lunches and snacks will be provided by parents. LPA observed a microwave and refrigeration for heating and storing meals if needed. There is no dishwashing equipment.

Center shall devise an Incidental Medical Service plan and provide to parents of children with allergies (epi-pen), asthmatic (inhalers), and children needing G-tube feeding

RESTROOMS

THERE WERE:

2 toilets and 1 urinals = 1 toilet per 15 children for a total of 45 children

3 sinks = 1 sink per 15 children for a total of 45 children

Toilets and sinks were age appropriate

SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2021
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: A - LIST MONTESSORI PRESCHOOL
FACILITY NUMBER: 197494947
VISIT DATE: 12/30/2021
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Toilets and sinks were age appropriate

The restrooms were clean and sanitized with the necessary toiletries, sinks and toilets were operable and in good repair. Faucets delivered cold water.

OUTDOOR ACTIVITY SPACE

Age appropriate toys and equipment were observed, applicant plans to use indoor/outdoor equipment. Toys were observed in good condition.

The play yard is a converted parking lot, completely gated with a 4 inch or higher gate. Applicant is informed that vehicles shall not use this area for drop offs.

No hazardous conditions or equipment was observed during today’s visit.

LPA did not observe any climbing apparatus, no resilient cushioning was observed

Water (pitcher or fountains) was available for outdoor water source

Applicant will use tents for shading, benches did not observe benches for resting during today inspection.

Measurements for the outdoor activity area were 836.55 divided by 75 sq. ft. per child for capacity total of 11 children.

SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2021
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: A - LIST MONTESSORI PRESCHOOL
FACILITY NUMBER: 197494947
VISIT DATE: 12/30/2021
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Center is requesting a waiver for Title 22, section 101238.2 for the purpose of accommodating the facilities indoor capacity

Based on todays inspection the facility shall be recommended for a capacity of 18 children determined by the indoor measurements.

Exit interview conducted and report was reviewed with the applicant Byanka Pecleb.

SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2021
LIC809 (FAS) - (06/04)
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