Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493135
Report Date: 10/17/2016
Date Signed: 10/17/2016 01:45:26 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:
10/17/2016
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Douha ZohbiTIME COMPLETED:
11:13 AM
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An Office meeting was held at the Regional Office on this morning. The applicant produced documents as they were referenced in the Evaluation Report dated 10/11/16.

The applicant provided copies of the following:

1. Complete records for the prospective director, Karina Nava, to include copies of attending orientation offered by the Department, qualification records, TB test and health screening (required immunization included), and pediatric CPR/1st aid training to expire on 6/22/18 through the American Heart Association. She is scheduled to attend Preventive Health and Screening training today; proof of enrollment was produced.

2. Updated Employee and parent handbooks.

3. Updated daily activity schedule to reference outside play time.

4. Photos of additional cots purchased.

5. Photos of child proof gates installed in the yard (to limit access to the back of the stage); photos of the large (2) slides removed and the covers installed at the openings.

6. Plan of Operation pertaining to offering Incidental Medical Services.

The facility was licensed at the conclusion of the meeting and the facility was processed for a provisional license for the capacity of 24 preschoolers. Copy of the facility file was generated at time of visit.

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

DATE: 10/17/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2016
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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