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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197420013
Report Date: 02/02/2022
Date Signed: 02/02/2022 03:50:11 PM

Document Has Been Signed on 02/02/2022 03:50 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:MONTESSORI WOODLAND HILLSFACILITY NUMBER:
197420013
ADMINISTRATOR:ZOHRA BAREKZAIFACILITY TYPE:
830
ADDRESS:6104 FALLBROOK AVENUETELEPHONE:
(818) 340-4404
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY: 18TOTAL ENROLLED CHILDREN: 10CENSUS: 8DATE:
02/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Luana Madarigal, Regional DirectorTIME COMPLETED:
12:30 PM
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On 02/02/2022 at 8:30 a.m. Licensing Program Analyst (LPA), Deborah Lowe conducted an unannounced Annual Required Inspection for the infant license. LPA met with Regional Director, Luana Madarigal, and toured the facility indoors and outdoors. Regular Days and hours of operation are Monday – Friday 6:30 a.m. – 6:00 p.m. Due to COVID facility stated temporary hours of operation are Monday – Friday 7:30 a.m. – 5:30 p.m.

There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible. No poisons were observed during the inspection.

Furniture and equipment are in good condition, free of sharp, loose or pointed parts. Playground equipment is in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All toilets and handwashing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe.

All food preparation and storage areas are clean, free of litter/rubbish and free of rodents/vermin. All food is protected against contamination and any contaminated food is discarded immediately. Infant bottles and food containers were observed with child name and current date. Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is available with the use of water cooler system.

Areas around high climbing equipment, swings and slides have cushioning material to absorb falls. The facility is free of flies, insects and rodents. There is a working carbon monoxide detector, LPA Lowe was able to hear a successful test.

LPA advised prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have received a criminal record clearance or exemption. Upon notification from the

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE: DATE: 02/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/02/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MONTESSORI WOODLAND HILLS
FACILITY NUMBER: 197420013
VISIT DATE: 02/02/2022
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Department, the licensee will comply and act immediately to terminate the employment of, remove from the facility or bar from entering the facility for any person it is deemed necessary while the Department considers granting or denying an exemption.

Capacity and limitations as specified on the license are being maintained. At least one person trained in CPR and Pediatric First Aid is present when children are at the facility or at offsite activities. The person who signs the child in/out of the facility shall use their full legal signature and record the time of day. All children are under supervision, including visual supervision, of a teacher at all times. There is a ratio of one teacher supervising no more than four infants in care. LPA Lowe observed 8 infants in direct supervision of 3 staff.

LPA reviewed the children’s files of children in attendance and observed files were complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child, medical assessment, individual feeding plan, and Infant Needs and Services Plan.

LPA reviewed Infant staff files of staff present during visit and observed files were complete with health screening, immunization records for influenza, pertussis and measles. Current documentation of mandated reporter training showed one staff file with an expired mandated reporter training. Staff records contain documentation of meeting infant staff education qualification requirements.

Menus are posted at least one week in advance where an authorized representative can view them. The facility has sufficient age appropriate furniture, and equipment including cribs, mats, changing tables and feeding chairs. There is indoor and outdoor activity space for infants that is physically separate.

Each crib, mat or cot is occupied by only one infant at time and cribs are kept free from all loose articles including blankets and pillows and there are no objects hanging above or attached to the crib. Infants are not swaddled while in care. Staff physically checks on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Documentation for infants up to 12 months includes sleeping position if it is other than on their back. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping. Staff-infant ratio requirements are being met while infants are sleeping.

Incidental Medical Services (IMS) are currently being provided. LPA advised licensee is that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022
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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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MONTESSORI WOODLAND HILLS
FACILITY NUMBER: 197420013
VISIT DATE: 02/02/2022
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Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.
The following items were discussed:

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/inspection-process.

Regional Director, Luana Madarigal 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.

LPA discussed the safe sleep regulations with Regional Director, Luana Madarigal and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Regional Director, Luana Madarigal of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

Licensee was provided a copy of this report and of their appeal rights.

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 and report was reviewed with the Regional Director, Luana Madarigal.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022
LIC809 (FAS) - (06/04)
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