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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750070
Report Date: 12/09/2024
Date Signed: 12/12/2024 01:24:06 PM

Document Has Been Signed on 12/12/2024 01:24 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:GRANADA HILLS MONTESSORI PRESCHOOLFACILITY NUMBER:
197750070
ADMINISTRATOR/
DIRECTOR:		VILLALOBOS, GLADYSFACILITY TYPE:
850
ADDRESS:11451 WOODLEY AVETELEPHONE:
(818) 360-7448
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 75TOTAL ENROLLED CHILDREN: 75CENSUS: DATE:
12/09/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Gladys Villalobos, DirectorTIME VISIT/
INSPECTION COMPLETED:
09:30 AM
NARRATIVE
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***THIS IS AN AMENDED REPORT WHICH SUPERSEDES THE PREVIOUS REPORT***
On 12/09/2024 at 09:30 AM, Licensing Program Analyst (LPA) Elicia Calvillo conducted an unannounced Case Management Visit. Facility is located at 11451 Woodley Avenue, Granada Hills, CA 91344. LPA identified self and met with Gladys Villalobos, Director, LPA identified reason for visit is to address information disclosed during an investigation by the Departments Investigation Branch (IB).

Facility Representative (FR) Gladys Villalobos, Director allowed entry into the facility and provided LPA a guided tour of inside and outside of the facility. The facility is currently licensed for a capacity of 75, per FR they currently have xx enrolled. The facility hours of operation are currently Monday thru Friday from 08:30 AM to 01:00 PM.

The IB Investigator conducted interviews, obtained Child Care Facility Roster, conducted a personnel record review, and obtained copies of other pertinent information and documents. It was discovered during this investigation that Staff #4 was aware that Staff #1 had a history of violating children’s personal rights and did not report all incidents to the Department.

During today’s visit, a Type B Deficiency was cited for 101212(d)(1)(C) Reporting Requirements, California Code of Regulations, Title 22, Division 12, Chapter 1, on the attached deficiency page and Plan of Correction

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.



Exit interview was conducted with Gladys Villalobos, Director, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE: DATE: 12/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2024
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 12/12/2024 01:25 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 12/11/2024 04:13 PM


Created By: Elicia Calvillo On 12/09/2024 at 09:44 AM
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: GRANADA HILLS MONTESSORI PRESCHOOL
FACILITY NUMBER: 197750070

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/16/2024
Section Cited
CCR
101212(d)(1)(C)(D)

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101212 Reporting Requirements (d) …, a report shall be made ... Department…next working day …, a written report …within seven days .... (1) Events…: (C) Any unusual incident… threatens the physical or emotional health or safety .... This requirement is not met as evidenced by:
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Per Director, they will conduct a staff meeting to review Reporting Requirements and provide LPA with a copy of the meeting agenda topics and staff sign sheet by the plan of correction due date of 12/16/2024.
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Based on observation, interview, record review, the licensee did not comply with the section cited above in that the IB investigator discovered during the investigation that Staff #4 was aware that Staff #1 had a history of violating children’s personal rights and did not report all incidents to the Department.
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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:Rita Ramos
LICENSING EVALUATOR NAME:Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:
DATE: 12/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2024


LIC809 (FAS) - (06/04)
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