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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017095
Report Date: 03/21/2022
Date Signed: 03/22/2022 07:50:37 AM

Document Has Been Signed on 03/22/2022 07:50 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:WALNUT MONTESSORI-PRESCHOOL ACADEMYFACILITY NUMBER:
198017095
ADMINISTRATOR:HARVINDERPAL VAGHELAFACILITY TYPE:
850
ADDRESS:3457 S. NOGALES STREETTELEPHONE:
(626) 965-9060
CITY:WEST COVINASTATE: CAZIP CODE:
91792
CAPACITY: 117TOTAL ENROLLED CHILDREN: 123CENSUS: 99DATE:
03/21/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Harvinderpal Vaghela, DirectorTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Thelma Razo made a subsequent Case Management - Incident inspection and met with Director Harvinderpal Vaghela. LPA stated the purpose of the visit.

On 2/25/2022, reported an unusual incident involving Child #1 (C1) who started to have swollen eyes and red patches on the face during lunch. LPA interviewed C1s parent, C1, Director, 4 staff and 4 children.

Various interviews have indicated that C1 is allergic to peanut, however, center is a nut free facility. LPA reviewed C1's file and confirmed that peanut allergy was noted on the file. LPA reviewed the facility allergy lists posted in each classrooms and kitchen. It showed the children's name, food allergies and classroom number which includes C1. LPA reviewed the facility menu and observed there were no nuts served. LPA observed there's no nuts in the kitchen. According to C1's parent, C1 will be tested for possible new food allergy. C1 is aware of food allergy and stated that C1 does not consume peanuts here in the center.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director Harvinderpal Vaghela.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Thelma Razo
LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2022
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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