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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494645
Report Date: 04/05/2023
Date Signed: 04/05/2023 02:24:44 PM

Document Has Been Signed on 04/05/2023 02:24 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
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: 57TOTAL ENROLLED CHILDREN: 57CENSUS: 32DATE:
04/05/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Director/Owner Noesh HordagodaTIME COMPLETED:
09:30 AM
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On 04/05/23 at 9:00 AM, Maria Rendon and Antonio Almanza, Licensing Program Analysts (LPAs) conducted an unannounced visit for the purpose of verifying corrections to Plan of Corrections (POCs). LPAs met with Noesh Hordagoda, Director and explained the purpose of the visit. During today’s visit there were 5 adults providing care and supervision to 32 children in care.

LPA’s Cleared 2 Plan of Corrections (POCs) for violations issued on 03/21/23 and POC letter was generated and provided to the Director.

A copy of this Report (809), Appeal Rights, and Notice of Site Visit (LIC 9213) were provided and explained to Director Noesh Hordagoda.

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE: DATE: 04/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/05/2023
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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