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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750070
Report Date: 07/19/2024
Date Signed: 07/19/2024 11:53:32 AM


Document Has Been Signed on 07/19/2024 11:53 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:GRANADA HILLS MONTESSORI PRESCHOOLFACILITY NUMBER:
197750070
ADMINISTRATOR:VILLALOBOS, GLADYSFACILITY TYPE:
850
ADDRESS:11451 WOODLEY AVETELEPHONE:
(818) 360-7448
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY:75CENSUS: 33DATE:
07/19/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Gladys Villalobos, DirectorTIME COMPLETED:
12:00 PM
NARRATIVE
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On 07/19/2024 at 09:05 AM, Licensing Program Analyst (LPA) Elicia Calvillo conducted an unannounced inspection visit to audit and review personnel records. LPA identified self and met with Gladys Villalobos, Director, who guided analyst on a tour of the inside and outside of the facility. LPA observed 33 children and 5 staff upon arrival.

During the inspection, LPA requested to audit and review the personnel records for Staff #1, Staff #2, and Staff #3. LPA requested to review termination records for Staff #1, Staff #2, and Staff #3.

At 09:20 AM, Gladys Villalobos, Director stated that there are termination personnel records available for LPA to audit and review.

At 09:34 AM, Director, spoke to Noesh Hordagaoda, Licensee who informed Director there are no termination personnel records for Staff #1, Staff #2, and Staff #3 for LPA to audit and review..

Although Gladys Villalobos, Director stated to LPA that there are termination personnel records available for audit and review, Licensee Noesh Hordagaoda, denied there are termination personnel records available for LPA to audit and review for Staff #1, Staff #2. and Staff #3,

LPA requested termination personnel records for Staff #1, Staff #2, and Staff #3 and termination personnel records were not readily available for LPA to audit and review.

Due to LPA not being provided the termination personnel records for Staff #1, Staff #2, and Staff #3 during the visit, a Type B Deficiency was issued for California Code of Regulations, Title 22, Section 101217 (d) Personnel Record.




SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Elicia CalvilloTELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:
DATE: 07/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/19/2024
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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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
VISIT DATE: 07/19/2024
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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, and Noesh Hordagoda, Licensee including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.
SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Elicia CalvilloTELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 07/19/2024 11:53 AM - It Cannot Be Edited

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: 07/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/24/2024
Section Cited
CCR
101217(d)

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101217 Personnel Records, (d) All personnel records shall be maintained at the child care center and shall be available to the licensing agency for review.

The requirement is not met as evidence by:
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Licensee stated that they will provide written documentation for termination for Staff #1, Staff #2, and Staff #3 and Director will provide LPA copy of the termination documentaiton by the Plan of Correction due date 07/24/2024.
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Based on observation,interview, record review, the licensee did not comply with the section cited above In that Personnel Records were not readily available upon request. which poses a potential health, safety or personal rights risk to persons 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: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Elicia CalvilloTELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:
DATE: 07/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/19/2024
LIC809 (FAS) - (06/04)
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