198020876-9-21-2022-33-CC-CGRN-CJGTVT-20220921150427

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020876
Report Date: 09/21/2022
Date Signed: 09/21/2022 03:04:50 PM

Document Has Been Signed on 09/21/2022 03:04 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	BLOSSOM MONTESSORI		FACILITY NUMBER:	198020876
ADMINISTRATOR:	CATHERINE ZENO		FACILITY TYPE:	850
ADDRESS:	5158 YORK BLVD		TELEPHONE:	(225) 931-3563
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90042
CAPACITY: 42	TOTAL ENROLLED CHILDREN: 42	CENSUS: 0	DATE:	09/21/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:39 PM
MET WITH:	Catherine Zeno, Sarah Platt, and Maria Karen Herrera		TIME COMPLETED:	03:15 PM

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An announced pre-licensing site inspection was conducted today by Licensing Program Analyst (LPA) Crystal Green to inspect and measure facility for capacity determination. The applicant is requesting to operate a Preschool Program. Licensing staff met with Applicants, Catherine Zeno, Sarah Platt, and Maria Karen Herrera, who guided analyst on a tour of the facility. The hours of operation will be Monday to Friday from 7:30am to 6pm.

At 01:40 pm, Licensing staff was guided through a tour of the proposed preschool classrooms. This facility has a total of 2 classroom. LPA inspected classroom A and classroom B. Furniture and equipment were inspected for age appropriateness and good repair. Toys were observed to be clean and safe. Individual storage space was observed available for each child within the classrooms. LPA observed the children to have access to 2 toilets 1 urinal and 2 sinks in classroom B. In classroom A, it was observed to have 2 toilets and 2 sinks. All toilets and sinks are in safe and sanitary operating conditions. LPA observed the preschool to have emergency/first aid kits located in each classroom. There are smoke detectors and fire extinguishers located throughout the facility. The work station area will be used as the designated ill isolation room. Ill children will use the staff restroom.

Report Continues Page 1 of 3.

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: BLOSSOM MONTESSORI	FACILITY NUMBER: 198020876
	VISIT DATE: 09/21/2022

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Licensing staff was guided through the outdoor activity space. The outdoor playground was inspected for safety, cushioning material, good repair and age appropriateness. LPA observed age appropriate play equipment and toys. There is adequate shade available to children via canopy. Water will be accessible to children via water pitcher and children will also have their individual sippy cup. Parents will provide AM/ PM snacks and Lunch.

Facility representative was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA reviewed with facility representative the LIC 311A, Records to Be Maintained at The Facility, for child’s records, personnel records, administrative records, and documents to be posted. Reports Continues Page 2 of 3

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: BLOSSOM MONTESSORI	FACILITY NUMBER: 198020876
	VISIT DATE: 09/21/2022

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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed- related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

At this time, the facility was observed to be operating in compliance with California Title 22 Regulations. An approved Fire Clearance has been received by the Department. Based on measurements obtained today, the capacity for the preschool will be 42 (forty-two) children

Exit interview was conducted with Applicant’s Catherine Zeno, Sarah Platt, and Maria Karen Herrera and a signed copy of this report was provided.

Reports Ends Page 3 of 3.

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

LIC809 (FAS) - (06/04)

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