198020331-10-29-2019-33-CC-BBEL-BHF3TJ-20191029183202

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020331
Report Date: 10/29/2019
Date Signed: 10/29/2019 06:32:19 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:	CREEKSIDE MONTESSORI PRESCHOOL		FACILITY NUMBER:	198020331
ADMINISTRATOR:	CAMILLE CORPODIAN		FACILITY TYPE:	850
ADDRESS:	18790 AMAR ROAD		TELEPHONE:	(626) 581-7353
CITY:	WALNUT	STATE: CA	ZIP CODE:	91789
CAPACITY:	108	CENSUS: 0	DATE:	10/29/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Corporate VP Bishan Seneviratne		TIME COMPLETED:	06:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	An announced Pre-licensing inspection was conducted on this date by Licensing Program Analyst (LPA) B. Emiko Bell in order to take measurements of the indoors and of the outdoor play space of a proposed Pre-school. The application was received by the Department on 07/09/19. Upon arrival, LPA was greeted and let into the facility by Corporate VP Bishan Seneviratne. Administrator Laura Winger, Director Camille Corpodian, Assistant Director Gricelda Santillan were also present. Administrator Winger and VP Seneviratne asisted LPA with measuring. Administrator Winger left the premises at 2:00 P.M. The proposed preschool is located in a stand alone building at the corner of Amar and Francesca. It will operate year-round. The proposed days and hours of operation are Monday-Friday 7:00 A.M. to 6:30 P.M. The Center will serve children ages 2-6 as long as they are out of diapers. There are five classrooms, a break room and the Director's office. All posting requirements were observed on the main Parent Board, which is located in the hallway directly in front of the entryway. There are also Parent Boards in each classroom on which the Daily Schedule, the snack menu, the school calendar, and the monthly newsletter.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR NAME: Betty Bell	TELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: CREEKSIDE MONTESSORI PRESCHOOL	FACILITY NUMBER: 198020331
	VISIT DATE: 10/29/2019

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Page 5/5

Based on measurements taken on this date, the maximum indoor capacity shall be for105 children. The maximum outdoor capacity shall be for 123 children. Applicant is currently applying for 108 preschoolers.

Fire clearance was granted on 08/20/19 for a capacity of 108 children.

Prior to licensure, the following will need to be received by LPA:
1. The rental agreement between the landlord and the corporation or the DBA.
2. All required paperwork for Bishan Seneviratne (verification of MMR/TDAP/influenza immunizations and a copy of his transcripts or degree).
3. The Articles of Incorporation with the State Seal on them.

During today's inspection, applicant provided LPA with transfer requests for fourteen (14) employees who need to be associated.

An exit interview has been conducted with and a copy of this report has been signed by and provided to Corporate VP Bishan Seneviratne. Appeal Rights have been provided and explained to same.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR NAME: Betty Bell	TELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019

LIC809 (FAS) - (06/04)

Page: 5 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: CREEKSIDE MONTESSORI PRESCHOOL	FACILITY NUMBER: 198020331
	VISIT DATE: 10/29/2019

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Page 4/5

The sign in and out books will be kept on a cabinet which is located in the hallway which leads to the classrooms.

The outdoor activity space runs alongside the north, west and south side of the Center. There is an exit door from each classroom and the main hallway which lead to the outdoor activity area. The outdoor activity area is surrounded on the north and the west by vinyl fencing, on the south side by a cement wall and on the east side by the Center. The play yard has blacktop,foam rubber cushioning, artificial turf and sand. Shade is provided by two covered patios and there are several trees. The play equipment appears to be safe and age appropriate. There is a storage area in the middle of the playground where the Earthquake kits are stored and which surrounds the power source; it is rendered inaccessible by a childproof latch. There are three drinking faucets on the playground,

Fire safety: There is a fire extinguisher in each hallway and one in each classroom. There is a smoke detector in each classroom, in each hallway and one in the reception area. There is one carbon monoxide detector in each classroom. There is a fire alarm system in the building.

The encumbered space on the playground is the storage area and the electricity shut off. Each classroom was measured wall to wall, as the sinks are built-in and the cubbies are hung on the wall.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR NAME: Betty Bell	TELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019

LIC809 (FAS) - (06/04)

Page: 4 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: CREEKSIDE MONTESSORI PRESCHOOL	FACILITY NUMBER: 198020331
	VISIT DATE: 10/29/2019

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Page 2/5

A.M snack, lunch, and a P.M. snack will be served. If children arrive prior to 8:00 A.M., they can bring their own breakfast to eat. Lunch will either be provided by parents or can be purchased for $4.00 a day through a private catering company called Little Fingers. The Center will provide A.M. and P.M. snack. A.M. snack will be served at 9:00 A.M., lunch will be served at noon, and P.M. snack will be served at 3:30 P.M. 100% apple juice will be served during A.M. and P.M. snack.

Though parents will provide sippy cups, there are drinking faucets with filtered water in each room. The Center will provide individual, disposable cups if a child does not have a sippy cup. In room 1, there are five sinks and one drinking faucet; in rm. 2, there is one sink and one drinking faucet; in rm. 3, there are four sinks and one drinking faucet; in rm. 4, there are four sinks and in rm. 5, there is one sink and one drinking faucet.

Incidental Medical Services: This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: www.ada.gov/childqanda.htm.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR NAME: Betty Bell	TELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019

LIC809 (FAS) - (06/04)

Page: 2 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: CREEKSIDE MONTESSORI PRESCHOOL	FACILITY NUMBER: 198020331
	VISIT DATE: 10/29/2019

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Page 3/5

Medications which require refrigeration will be stored in a locked box in the refrigerator in the break room. Medications which do not require refrigeration will be stored in a locked box which will be kept on top of the refrigerator in the break room. The cleaning supplies will be kept in the storage room which is locked by key and disinfectants will be stored in the nook in each classroom. There is a First Aid Kit in a cabinet by the microwave in each classroom.

There is age-appropriate furniture and equipment in each room. There is a landline and a cordless phone in the Director's office, the reception area and in each classroom. Each classroom has central heating and air-conditioning. Overhead lighting provides the majority of the light in each classroom, but natural lighting comes through the windows of each classroom as well. When children become ill during school hours, the Center will call their parent. The Director's office will be used as an isolation room,

There is a designated changing mat, which is kept in the storage closet of room 4. There is a staff restroom located in the main hallway. There is a restroom which adjoins rooms 1 and 2, a restroom which adjoins rooms 3 and 4, and a restroom which adjoins rooms 4 and 5. There are a total of eleven (11) toilets.

For napping equipment, cots are stored in the storage closet in each room. A total of 100 cots were counted today.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR NAME: Betty Bell	TELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019

LIC809 (FAS) - (06/04)

Page: 3 of 5