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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494645
Report Date: 10/25/2023
Date Signed: 10/25/2023 03:28:10 PM

Document Has Been Signed on 10/25/2023 03:28 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: 37DATE:
10/25/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Sharon C & Darlene C.TIME COMPLETED:
01:00 PM
NARRATIVE
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On 10/25/23, Licensing Program Analyst (LPA) V. Wheatley conducted an unannounced inspection and met with Director Sharon Collins and Administrator Darlene Cabrera. LPA toured the premises and observed 37 preschool children today. LPA counted the children on the larger playground and observed one teacher Staff #1 with 20 children. LPA was informed that Staff #2 was assigned to the group and took two children to the restroom. There were enough staff on the premises.

Based on LPA's observance, the facility is being cited for operating out of ratio.

See LIC 809D.

Exit interview conducted. A copy of report provided.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Veronica Wheatley
LICENSING EVALUATOR SIGNATURE: DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2023
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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Document Has Been Signed on 10/25/2023 03:28 PM - It Cannot Be Edited


Created By: Veronica Wheatley On 10/25/2023 at 12:42 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: WOODLAKE MONTESSORI PRESCHOOL
FACILITY NUMBER: 197494645

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/25/2023
Section Cited
CCR
101216.3(a)

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101216.3(a) -There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance.
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Licensee and director will ensure the facility is operating within required ratios at all times. Licensee / director will submit a plan of correction to the Department by 10/26/23. Licensee will submit a plan of how this will be prevented and also meet with staff regarding communication and counting the children.
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This is evidenced by:
LPA Wheatley observed one staff member Staff #1 alone with 20 children outside in the outdoor play space. LPA was informed the other Staff #2 went to the restroom with two children. This is a potential risk to the health and safety to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Maureen Neal
LICENSING EVALUATOR NAME:Veronica Wheatley
LICENSING EVALUATOR SIGNATURE:
DATE: 10/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2023


LIC809 (FAS) - (06/04)
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