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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566216042
Report Date: 10/01/2024
Date Signed: 10/01/2024 12:47:29 PM

Document Has Been Signed on 10/01/2024 12:47 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:SIMI VALLEY MONTESSORI SCHOOL - WEST VALLEYFACILITY NUMBER:
566216042
ADMINISTRATOR/
DIRECTOR:		ROSHINI WIREKOONFACILITY TYPE:
830
ADDRESS:15 MCCOY PLACETELEPHONE:
(818) 667-5205
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY: 11TOTAL ENROLLED CHILDREN: 11CENSUS: 8DATE:
10/01/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:31 AM
MET WITH:Roshini WirekoonTIME VISIT/
INSPECTION COMPLETED:
01:31 PM
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On October 1, 2024 at 11:31 AM, Licensing Program Analyst (LPA) Aaliyah Zendejas conducted an unannounced Required - 3 Year inspection. LPA met with Director Roshini Wirekoond and announced the purpose of the inspection. Together with Director Roshini Wirekoon provided LPA with a tour of the interior and exterior of the facility. At the time of the inspection, there were eight children under the care and supervision of two staff members.

LPA observed required licensing documents mounted on the walls before entering facility. Last fire drill was conducted on September 17, 2024. The classroom had age-appropriate toys and furniture readily accessible for children in care. LPA observed a diaper changing table within the infant classroom. LPA did not observe any hazards/toxins items accessible to children. A first aid kit is readily available for use in one of the classrooms within the facility. Facility does not provide anything for infants in regards to meals, all infants bring their preferred meals from home. The outdoor playground has shaded areas for children in care 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. Nap time takes place within the infant classroom. Staff is conducting 15 minute checks for the infants and documenting them.

A sampling of children and staff records were reviewed. LPA reviewed four children's files and observed children's files to be complete and current. Currently the facility does not have children that require Incidental Medical services (IMS). LPA observed staff files to be complete and current. Staff present have current CPR with an expiration date of 03/17/2025. All Staff present have current mandated reporter training certification. LPA verified SB792 Child Care Adult Immunization and Tuberculosis requirements for all staff.

CON'D 809-C
SUPERVISORS NAME: Lissete Gonzalez
LICENSING EVALUATOR NAME: Aaliyah Zendejas
LICENSING EVALUATOR SIGNATURE: DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/01/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: SIMI VALLEY MONTESSORI SCHOOL - WEST VALLEY
FACILITY NUMBER: 566216042
VISIT DATE: 10/01/2024
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

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.



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 Roshini Wirekoon.

SUPERVISORS NAME: Lissete Gonzalez
LICENSING EVALUATOR NAME: Aaliyah Zendejas
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
LIC809 (FAS) - (06/04)
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