566214333-4-28-2022-17-CC-DTHN-CDWRV5-20220428132057

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566214333
Report Date: 04/28/2022
Date Signed: 04/28/2022 01:21:03 PM

Document Has Been Signed on 04/28/2022 01:21 PM - 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	MONTESSORI ONE		FACILITY NUMBER:	566214333
ADMINISTRATOR:	AMAL PELAWATTA		FACILITY TYPE:	850
ADDRESS:	620 TRIUNFO CANYON ROAD		TELEPHONE:	(805) 777-8833
CITY:	WESTLAKE VILLAGE	STATE: CA	ZIP CODE:	91361
CAPACITY:	91	CENSUS: 70	DATE:	04/28/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Amal Pelawatta		TIME COMPLETED:	01:38 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	On April 28, 2022 at 11:00 AM, Licensing Program Analysts (LPA) Dean Thompson and Susana Martinez conducted an unannounced Annual/Random inspection. LPA conducted the Covid-19 screening questions prior to entering the facility. LPA met with Director Amal Pelawatta and advised the purpose of the inspection. Director provided LPA a tour of the facility inside and out. There were 70 children in care at the time of the inspection. LPA observed required licensing documents mounted on the wall inside the lobby. Last fire drill was conducted on 2/15/2022. Each of the classrooms have age-appropriate toys and furniture readily accessible for children in care. LPA observed enough restrooms available for children to use. LPA did not observe any hazards/toxins items accessible to children. First Aid kits were observed throughout the facility. Facility provides morning and afternoon snacks. Children bring their own lunch and water bottles from home. The outdoor playground is shaded and has an ample amount of space for children to play. LPA observed the playground has age-appropriate toys and structures available for children to use. LPA observed a plastic door with jagged edges on the childrens playhouse. LPA informed director the door or entire playhouse needs to be removed. A sampling of children and staff records were reviewed. LPA observed children's files to be complete and current. CPR current with an expiration date of 11/2023. LPA verified SB792 Child Care Adult Immunization and Tuberculosis requirements. Director was reminded a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter certification AB1207 every two years at www.mandatedreporterca.com Continued on 809-C

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Dean Thompson	TELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022

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 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: MONTESSORI ONE	FACILITY NUMBER: 566214333
	VISIT DATE: 04/28/2022

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

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated 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: http://www.ada.gov/childqanda.htm

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

PIN 22-06-CCP - Lead Testing in Child Care Centers – Frequently Asked Questions
PIN 21-21-CCP - Release of the Written Directives for Lead Testing of Water in Licensed Child Care Centers Per AB 2370
External Water Sampler Self-Certification Form (LIC 9275)
Child Care Center Sampling Checklist Form (LIC 9276)

No deficiencies were cited.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted, appeal rights were given, and report was reviewed with director Amal Pelawatta

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Dean Thompson	TELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022

LIC809 (FAS) - (06/04)

Page: 2 of 2