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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191225566
Report Date: 06/05/2019
Date Signed: 06/05/2019 09:01:41 AM

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:MONTESSORI CHILDREN'S ACADEMIEFACILITY NUMBER:
191225566
ADMINISTRATOR:WAHEEDA HAMIDFACILITY TYPE:
850
ADDRESS:2400 W. BURBANK BLVD.TELEPHONE:
8188421812
CITY:BURBANKSTATE: CAZIP CODE:
91506
CAPACITY:82CENSUS: 18DATE:
06/05/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
07:20 AM
MET WITH:Rima Hovsepian, Lead Teacher and Lorryn Jackson, Assistant DirectorTIME COMPLETED:
09:00 AM
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On 6/4/2019 7:20am Licensing Program Analyst LPA Miranda conducted an unannounced visit for the purpose of a plan of Correction visit. (Poc) to ensure the deficiency cited on previous visit of 5/30/2019 . Upon arrival LPA met the lead Teacher Rima Hovsepian. At 7:20am on the initial visit of 6/5/19, LPA observed the Lead, and three Teachers caring for a total of 3 children.

On 5/30/19 Licensee was cited for the following deficiency: 1) Over capacity:

At 8:05am LPA met the Assistant Director, Lorryn Jackson and informed the purpose of this visit. At 8:07am LPA observed four teachers and Director caring for a total of 18 children.

LPA obtained copies and reviewed of sign in/sign out and from 5/31/19 to 6/4/2019 and children’s attendance. Also, LPA observed the capacity of 6/5/2019 the facility was in compliance.

LPA reviewed the children's files and observed the acknowledge of receipt of licensing reports (LIC 9224) signed by parents and placed in the files.

At the time of the plan of correction visit the facility was found to be in substantial compliance.

Exit interview conducted, notice of site visit, and POC letter was provided to Lorryn Jackson, Assistant Director on 06/5/2019.

SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2019
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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