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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400897
Report Date: 01/23/2024
Date Signed: 01/23/2024 09:57:09 AM

Document Has Been Signed on 01/23/2024 09:57 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:ACADEMIA MONTESSORIFACILITY NUMBER:
198400897
ADMINISTRATOR:BALGEMINO, JANICEFACILITY TYPE:
830
ADDRESS:15108 STUDEBAKER ROADTELEPHONE:
(562) 338-4737
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 16TOTAL ENROLLED CHILDREN: 16CENSUS: 15DATE:
01/23/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Janice BalgeminoTIME COMPLETED:
10:00 AM
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On January 23, 2024, at 9:10 AM, Licensing Program Analysts (LPA) Elka Chavez conducted an announced Pre-Licensing follow up inspection for a Change of Ownership new license. Upon arrival, LPA met with Director, Janice Balgemino, the applicant, Knoller Montessori LLC.

The applicant made the following corrections:

· Applicant placed a portable changing table in the staff/ill isolation restroom.
· Applicant placed the Parent Board in an accessible area to parents.

At 9:30 AM, LPA observed the portable changing table in the staff/ill isolation to have 1 inch thick padded surface, easy to clean waterproof pad, 5 inch raised and padded barrier on all four sides and while in use,it will be placed within arm's reach of the sink. LPA observed the portable changing table to have wheel locks. LPA observed the sink in the infant classroom and toddler classroom to be located within arm's reach of a sink.

At 9:35 AM, LPA observed the Parent Board to be posted outside of the toddler classroom in an accessible area.

Exit interview conducted and report was reviewed with the Director, Janice Balgemino.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Elka Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 01/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2024
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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