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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495117
Report Date: 02/11/2025
Date Signed: 02/13/2025 11:01:36 AM

Document Has Been Signed on 02/13/2025 11:01 AM - 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:ABC PRE SCHOOL HOUSEFACILITY NUMBER:
197495117
ADMINISTRATOR/
DIRECTOR:		NINELIE RATAVOSSIANFACILITY TYPE:
850
ADDRESS:4102-4104 W VICTORY BLVDTELEPHONE:
(818) 934-0049
CITY:BURBANKSTATE: CAZIP CODE:
91505
CAPACITY: 53TOTAL ENROLLED CHILDREN: 53CENSUS: 50DATE:
02/11/2025
TYPE OF VISIT:Case Management - DeficienciesANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:58 PM
MET WITH:Shamalie Goomewardene, OwnerTIME VISIT/
INSPECTION COMPLETED:
04:50 PM
NARRATIVE
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On 02/11/2025 Licensing Program Analyst (LPA) Laticia Thompson conducted an announced increase in capacity visit. During todays visit at approximately 2:30 P.M. LPA observed 11 children in classroom #2 (TK & Kindergarten) unsupervised. Within 2-3 minutes Staff #1 appeared. S#1 stated she left the children briefly to get a Band-Aid. LPA advised S#1 that no children shall be left without the supervision of a teacher at any time.
The facility was issued one Type A citations in violation of Title 22 regulations. (See LIC 809-D for deficiency page).

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form (LIC 9224) must be maintained in each child’s file immediately upon receipt from parent. Applicant was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.



An exit interview was conducted with Shamalie Goomewardene, Owner. A copy of this facility evaluation report (LIC 809 & LIC 809D), Appeal Rights (LIC9058) and Notice of Site Visit (LIC9213) were reviewed and provided to Owner.
SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/11/2025
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 02/13/2025 11:01 AM - It Cannot Be Edited


Created By: Laticia S Thompson On 02/11/2025 at 04:12 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: ABC PRE SCHOOL HOUSE
FACILITY NUMBER: 197495117

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/11/2025
Section Cited
CCR
101229(a)(1)

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Responsabilities for Providing Care and Supervision
The licensee shall provide...supervision;.No child(ren) shall be left without the supervision...at any time;.. shall include visual observation.
This Requirement has not been met as evidence by
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Staff wil receive a letter from Owner related to Empolyment expection. Owner will have S#1 to review supervision video located on CCLD website. S#1 will be required to provide proof of of completion.
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Based on observation S#1 did not have visual observation of 11 children in classroom #2
Which poses an immediate, health, safety and personal rights risk to children in care.
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Owner will give a letter to S#1 of disciplinary action.

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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:Deborah Lowe
LICENSING EVALUATOR NAME:Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 02/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/11/2025


LIC809 (FAS) - (06/04)
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