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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015361
Report Date: 08/08/2019
Date Signed: 08/08/2019 03:15:52 PM

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:HACIENDA MONTESSORI ACADEMYFACILITY NUMBER:
198015361
ADMINISTRATOR:MARIA ROSSFACILITY TYPE:
850
ADDRESS:15694 TETLEY STREETTELEPHONE:
(626) 333-5566
CITY:HACIENDA HEIGHTSSTATE: CAZIP CODE:
91745
CAPACITY:49CENSUS: 26DATE:
08/08/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:37 PM
MET WITH:Melody StephensTIME COMPLETED:
03:20 PM
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Case management inspection for capacity increase conducted by Licensing Program Analyst Jennifer Hua. LPA met with teacher in charge, Melody Stephens. Director Mai Trinh is not present during this visit. Licensee is seeking to increase capacity from 49 to 68 capacity. LPA toured the facility with teacher Melody according to facility sketch that was submitted. LPA observed the classrooms are clutter in some areas. Teacher stated that due to new shelves and cabinets being installed, some of the stuff are on the floors/counters, normally it's clutter free. LPA also observed the new classroom #3C (formerly teacher lounge) has not been set up for classroom activities.

LPA also observed there is no classroom #4 and classroom #3C as indicated on the facility sketch.
The facility sketch also did not reflect the 2 children bathrooms located in Room #2.

Measurements were not taken today due to classroom not yet ready and the facility sketch submitted does not accurately reflect the actual number of classrooms and bathrooms.

Licensee shall contact LPA once classroom is set up.
Licensee shall submit a revised facility sketch to accurately reflect the actual number of classrooms and bathrooms. Corrections shall be completed by 9/8/19.

Based on observation today, there are a total of 4 classrooms - Room #1, #2, #3A and #3C (New Room).

Rooms shall be labeled according to what is indicated on the facility sketch.

An exit interview conducted with teacher Melody Stephens, a copy of the report given. Notice of Site Visit form posted. The notice shall be posted for 30 days or a civil penalty of $100 will be assessed.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 513-3793
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019
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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