198021122-2-24-2023-33-CC-CGRN-CPCTRD-20230224135722

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198021122
Report Date: 02/24/2023
Date Signed: 02/24/2023 01:57:33 PM

Document Has Been Signed on 02/24/2023 01:57 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:	CREATIVE MIND PRESCHOOL		FACILITY NUMBER:	198021122
ADMINISTRATOR:	SIRIWARDANA, IMESHA		FACILITY TYPE:	850
ADDRESS:	5262 FOUNTAIN AVENUE		TELEPHONE:	(323) 715-6846
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90029
CAPACITY: 51	TOTAL ENROLLED CHILDREN: 51	CENSUS: 25	DATE:	02/24/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Imesha Siriwardana		TIME COMPLETED:	02:10 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	An announced pre-licensing site inspection was conducted today by Licensing Program Analyst (LPA) Crystal Green to inspect and measure facility for capacity determination. Licensing staff met with Imesha Siriwardana, Applicant and Guadalupe Cervantes, Director. Also present during this inspection were the current licensee, Brigitte Benchimol. The applicant is requesting for a Change of Ownership for an existing Preschool Program. Facility location is currently operating as Creative Mind Preschool (198018412). The proposed hours of operation will be Monday to Friday from 7am to 6pm. At 10:40 am, Licensing staff was guided through a tour of the proposed preschool classrooms. The facility is currently operating, LPA observed a total of 25 children with 4 staff members. This facility has a total of 4 classrooms. Individual storage space was observed available for each child in each of the designated indoor areas. LPA observed cots available in each classroom. LPA observed a total of 5 toilets and 5 sinks available for children indoors. All toilets and sinks are in safe and sanitary operating conditions. Water will be accessible to children via water pitcher and deposable cup and children will also have their individual sippy cup. 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 office will be used as the designated ill isolation room. Staff have their own restroom in the director’s office. This restroom will also be used for ill children. Licensing staff was guided through the outdoor activity space. There is also 1 toilet in the outside play area with a nearby sink for handwashing. 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 canopies Report Continues Page 1 of 3.

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE:	DATE: 02/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2023

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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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: CREATIVE MIND PRESCHOOL	FACILITY NUMBER: 198021122
	VISIT DATE: 02/24/2023

NARRATIVE

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There is a kitchen on the premises that is off-limits to children. The kitchen is located in the back of the facility adjacent to classroom #4. The door of the kitchen has a latch and will be kept locked. Facility will continue to provide snacks and lunch will be provided by parents. Facility does not have the means to prepare meals.

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.

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.

Report Continues 2 of 3.

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE:	DATE: 02/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2023

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: CREATIVE MIND PRESCHOOL	FACILITY NUMBER: 198021122
	VISIT DATE: 02/24/2023

NARRATIVE

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An approved Fire Clearance has been received by the Department. Based on measurements obtained today, capacity for indoor activity space measured for 51 children and the outdoor activity space measured for 44 children. LPA consulted with the applicant regarding information needed to submit an outdoor waiver request in order to obtain the capacity requested. LPA informed applicant that waivers are not automatically granted and will need to be review by the Monterey Park Regional Office for final approval. LPA obtained pictures of the outdoor play areas during this inspection.

The following correction needs to be made before receiving final approval. Correction will be due by 03/15/2023.

The existing licensee will need to submit proof of door notification such as an alarm or bell placed on (3) doors leading to the outdoor playarea.
An Outdoor Waiver Request will need to be reviewed, submitted and approved by the Regional Office in order to obtain the requested capacity of 51 preschoolers.

Exit interview was conducted with Applicant, Imesha Siriwardana and a signed copy of this report was provided.

Report Ends Page 3 of 3.

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE:	DATE: 02/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2023

LIC809 (FAS) - (06/04)

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