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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197494645
Report Date: 03/21/2023
Date Signed: 03/21/2023 02:51:37 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/14/2023 and conducted by Evaluator Antonio Almanza
PUBLIC
COMPLAINT CONTROL NUMBER: 58-CC-20230314142323
FACILITY NAME:WOODLAKE MONTESSORI PRESCHOOLFACILITY NUMBER:
197494645
ADMINISTRATOR:HORDAGODA, NOESHFACILITY TYPE:
850
ADDRESS:23363 BURBANK BLVDTELEPHONE:
(323) 767-4517
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY:57CENSUS: 30DATE:
03/21/2023
UNANNOUNCEDTIME BEGAN:
08:52 AM
MET WITH:Assisstant Director Darlene Cabrera & Director Noesh Hordagoda TIME COMPLETED:
11:59 AM
ALLEGATION(S):
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Allegation 1 - Staff do not properly safeguard the facility grounds while daycare children are present.

Allegation 2 - Staff do not properly maintain the outdoor activity space
INVESTIGATION FINDINGS:
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On 3/21/2023 at 8:52 AM, Maria Rendon and Antonio Almanza, Licensing Program Analysts (LPAs), conducted an unannounced site visit for the purpose of investigating complaint allegations received by the department on 03/14/23 associated to Complaint Control Number 58-CC-20230314142323. LPA's met with Darlene Cabrera, Assistant Director and explained the purpose of the visit. During today’s visit there are 8 adults providing care to 30 preschool children. Director Noesh Hordagoda arrived at the facility at 10:45 AM.

During today’s visit, LPA’s made observations and conducted interviews regarding aformmentioned allegations.

Allegation 1 - Staff do not properly safeguard the facility grounds while daycare children are present. pg 1.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 58-CC-20230314142323
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: WOODLAKE MONTESSORI PRESCHOOL
FACILITY NUMBER: 197494645
VISIT DATE: 03/21/2023
NARRATIVE
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Based on LPA's observation and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California code of Regulations, Title 22, Division 12 & Chapter 1, are being cited on the attached LIC9099D.


A copy of this Report, Notice of Site Visit, and Appeal Rights were explained and provided to , Assistant Director.

LPA's left the facility at 12:24 PM and returned at 2:20 PM







Pg 3.
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 58-CC-20230314142323
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: WOODLAKE MONTESSORI PRESCHOOL
FACILITY NUMBER: 197494645
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/27/2023
Section Cited
CCR
101238.2(g)
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101238.2(g), Outdoor Activity Space, The playground shall be enclosed by a fence to protect children and to keep them in the outdoor activity area. The fence shall be at least four feet high.

This Requirement is not met as evidenced by:
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Facility agrees to make corections to the gates and fence in order to keep children in the facility safe and from going out of the facility.
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Based on observation, and interview, The fence along the back of the playground is under four feet, back gate does not close, and the front gate is proped open by parents, which poses an immediate or Health and Safety, and personal rights risk to persons in care.
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Facility will have corections completed by 03/27/23.
Type A
03/27/2023
Section Cited
CCR
101238.2(d)(2)
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101238.2(d)(2), Outdoor Activity Space, Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard.

This Requirement is not met as evidenced by:
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Facility agrees to make corections to the dirt in the play area.
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Based on observation, and interview, The dirt in the play area has been been turned, is uneven and is a hazard for children to play in, which poses an immediate or Health and Safety, and personal rights risk to persons in care.
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Facility will have corections completed by 03/27/23.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4