Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493135
Report Date: 10/11/2016
Date Signed: 10/11/2016 03:12:36 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME:EXPLORING MINDS MONTESSORI HAZELTINEFACILITY NUMBER:
197493135
ADMINISTRATOR:LIIANA LOPEZFACILITY TYPE:
850
ADDRESS:5128 HAZELTINE AVETELEPHONE:
(818) 312-3575
CITY:SHERMAN OAKSSTATE: CAZIP CODE:
91423
CAPACITY:24CENSUS: 0DATE:
10/11/2016
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Douha Zohbi, applicantTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Khadarian conducted an announced site visit upon receipt of an application for a child care center. The fire inspector has approved the capacity of 24 children requested, based on the maximum number under the certificate of occupancy issued by the City. The applicant is a licensed provider of another facility (license # 197410411). This facility will operate Monday through Friday, from 8:30 am to 4:00 pm.

The facility is converted residential property. It is comprised of two large classrooms that open to each other. Classroom # 2 (to the left of the property upon entrance from the main door) was measured to be: (29.6 x 17) - (3.5 x 8.10 - adult restroom area) = 503.2 - 28.35 = 474.85 sq. ft
The adult restroom adjacent to this room will be used by sick children as well.

Classroom # 1 was measured to be: (19.4 x 14.1) + (12.8 x 24.1) + (9.5 x 7.7) = 273.54 + 308.48 + 73.15 = 655.17 sq. ft. There is a fire place in this room that was made inaccessible by a fish tank placed inside.

The total indoor space of 1130.02 will allow a capacity of 32 preschoolers.

There is a full size kitchen that will be used to prepare snacks. The kitchen is equipped with full size refrigerator and a sink with hot and cold running water. The kitchen is completely off limits to the daycare children and LPA observed child proof gates installed at both (2) entrances of the kitchen.

The office is located adjacent to classroom # 1; it will be used to isolate/rest sick children. Drinking water will be offered in the classrooms by a water dispenser.

There is a restroom that is accessible through Classroom # 1 as well as the yard. This will be used by the
SUPERVISOR'S NAME: Scott HerringTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Shoghig KhadarianTELEPHONE: (310) 337-4308
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2016
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, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME: EXPLORING MINDS MONTESSORI HAZELTINE
FACILITY NUMBER: 197493135
VISIT DATE: 10/11/2016
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children. LPA observed 3 toilets and 3 sinks that will accommodate a total of 45 preschoolers.

The classrooms were observed to be set up with age appropriate toys and equipment. There are children's cubbies to store their belongings.

The backyard is completely fenced in and there are no bodies of water observed. The outdoor space was observed to be set up with different types of activities, and separated with short fence and ramp. There is a large play equipment with 2 large slides. One slide is covered. There are cushioning material under the play equipment and other parts of the yard. On the other side, there is a large stage set up for performances by the children. The back part of the property includes parking spaces and detached/converted garage. These areas will be completely off limits to the daycare children and children will not be received from this end of the property.

There are large shade structures installed to provide shade on most part of the yard.

The outdoor space was measured to be: (61.3 x 31.5) + (35 x 29) = 1930.95 + 1015 = 2945.95 sq. ft. which will accommodate a total of 39 preschoolers. When outdoors, the children will be offered drinking water in pitchers.

During this visit, the applicant provided an updated application to reflect the total of 24 preschoolers only. The original application reflected the request of 24 children including 4 toddler option. Applicant stated that was an error on her part and that she never intended on pursuing a toddler option.

Also, during the visit, the prospective director arrived. She was the provider of the home daycare licensed at this address (facility license # 197419632). The prospective director completed a statement requesting surrendering her license. The home daycare facility will be closed effective today so as to continue the processing of this application.

The facility will be processed for the capacity of 24 children upon completion of the following:

1. The applicant decided upon another staff to accept the duties of a director. The applicant will submit copies of records for Ms. Karina Nava, as required, including an updated LIC 500 reflecting the new director's name.
SUPERVISOR'S NAME: Scott HerringTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Shoghig KhadarianTELEPHONE: (310) 337-4308
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2016
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, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME: EXPLORING MINDS MONTESSORI HAZELTINE
FACILITY NUMBER: 197493135
VISIT DATE: 10/11/2016
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2. The applicant will submit photos of the play equipment modified. The applicant is unable to produce age appropriateness information (sticker, playground safety report, etc). The LPA expressed concern about the size of the (2) slides, height and angle. The applicant stated she will remove the 2 slides, and place barriers to cover the opening. Photos will be submitted.
3. The LPA discussed supervision concerns about the stage placed in the yard. It would provide opportunities for children to hide and be outside perimeters of adult supervision. The applicant agreed to place barriers such as a gate to limit access to this area.
4. The applicant will purchase additional cots and/or mats. There are currently only 6 cots. The number should meet the number of capacity requested
5. The applicant will update the daily activity schedule to reflect clearly the outdoor times.
6. The applicant was discussed that this facility and the one that she is currently licensed for should operate separately and independently, although she may request associating of staff to both locations to ensure compliance with the Regulation requirements.

The following was discussed during this visit:

1. The applicant was reminded to access the Licensing website at ccld.ca.gov to obtain information about the most recent regulatory changes, and especially the Quarterly Updates.
2. Incidental Medical Services was discussed with the applicant. Per parent handbook, they will not administer medication. However, the applicant stated they will accept children who require certain incidental medical services. The applicant will submit an updated plan of operation. The LPA discussed the ADA obligation of the applicant as they related to providing incidental medical services (IMS). LPA referenced the Title 22 Regulation Interpretations and Procedure Section 101173 and 101226.
3. The applicant was informed about the Healthy Schools Act and the required training to be completed.
4. Senate Bill 792 was discussed pertaining the requirement of immunization for staff working at child care facilities.

Copy of this report was provided. Exit interview.
SUPERVISOR'S NAME: Scott HerringTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Shoghig KhadarianTELEPHONE: (310) 337-4308
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2016
LIC809 (FAS) - (06/04)
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