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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400822
Report Date: 11/14/2023
Date Signed: 11/14/2023 01:56:27 PM

Document Has Been Signed on 11/14/2023 01:56 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:BLOOMING MINDS PRESCHOOLFACILITY NUMBER:
198400822
ADMINISTRATOR:ADHARSHI DEEPTHIKA PERERAFACILITY TYPE:
830
ADDRESS:10225 OLD RIVER SCHOOL ROADTELEPHONE:
(818) 336-8624
CITY:DOWNEYSTATE: CAZIP CODE:
90241
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
11/14/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Adharsi Perera & Shervin PereraTIME COMPLETED:
02:00 PM
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An office meeting was conducted with Applicant, Adharshi Perera, also present, Shervin Perera. The purpose of this meeting is to discuss and review the pending application that was received on 05/24/2023.

The following was discussed with the Applicant and items that need to be updated:

· Parent and Employee handbook.
· Job descriptions.
· Admissions Agreement.

Applicant states that she will provide all missing documents & updated documents by 11/15/2023.

Exit interview conducted with Adharshi Perera, Applicant who is in agreement with this report which documents this meeting. Appeal Rights were given.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Elka Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 11/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2023
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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