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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018485
Report Date: 01/18/2023
Date Signed: 01/18/2023 11:09:27 AM

Document Has Been Signed on 01/18/2023 11:09 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 INTERNATIONAL MONTESSORI PRESCHOOLFACILITY NUMBER:
198018485
ADMINISTRATOR:DR. CHENGUANG YANGFACILITY TYPE:
850
ADDRESS:20781 AMAR ROAD #1TELEPHONE:
(909) 594-8172
CITY:WALNUTSTATE: CAZIP CODE:
91789
CAPACITY: 118TOTAL ENROLLED CHILDREN: 120CENSUS: 33DATE:
01/18/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Amynah Moloo & Noelle SevillaTIME COMPLETED:
11:15 AM
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Case management inspection conducted by Licensing Program Analyst Jennifer Hua. LPA met with assistant director Amynah Moloo. A Covid-19 risk assessment was conducted. The purpose of the visit was announced. Census was taken. The purpose of this visit is to follow up on the incident that was reported on 1/4/2023. It was reported that on 1/3/2023, while child was waiting for pick up in the hallway, child was having a hard time with transition, crying and crawling not sitting down in the chair. When staff tried to get child off the ground staff accidentally pulled child's arm resulting in injury. Assistant director stated that director is on her way. Director Noelle Sevilla arrived at 9:17am.

During the visit, interviews were conducted with assistant director, director and staff. Video footage of the incident was also viewed.

Base on information received and reviewed of video footage. No deficiency cited at this time.

An exit interview conducted with director. Notice of Site Visitor form was provided. The notice shall be posted for 30 days accessible for review or a civil penalty of $100 will be assessed.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Jennifer Hua
LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2023
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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