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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191201813
Report Date: 03/14/2022
Date Signed: 03/14/2022 12:02:23 PM


Document Has Been Signed on 03/14/2022 12:02 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:GLENDALE MONTESSORI SCHOOLFACILITY NUMBER:
191201813
ADMINISTRATOR:ANDREA VENTURAFACILITY TYPE:
850
ADDRESS:413 WEST DORANTELEPHONE:
(818) 240-9415
CITY:GLENDALESTATE: CAZIP CODE:
91203
CAPACITY:73CENSUS: 47DATE:
03/14/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Andrea Ventura, Director and Anita Tuchrello, PrincipalTIME COMPLETED:
12:10 PM
NARRATIVE
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Licensing Program Analyst (LPA), Anomeh Eivazian, conducted an unannounced case- management inspection to the above facility on 03/14/2022 at 8:30 a.m.. LPA met with Andrea Ventrua, director who guided LPA on a tour of the facility. During this inspection there were total of 47 children present in the facility.

During this inspection staff#1 was present in Room A who does not have finger print clearance in Licensing Information System (LIS). During this inspection LPA Eivazian contacted Monterey Park Regional Office and talked to Esther Davila-Aguilar who checked in Guardian and LIS and did not find any criminal record clearance information for staff#1.

On 03/03/2022 Child#1 hit child #2 with a wooden block during outdoor play time at sand playarea, and child#2 sustained a small opening on the left side corner of the eye by the end of eyebrow line. Facility has not reported this incident to licensing yet.

The following are being cited in accordance to Title 22 of the California Code of Regulations. Please refer to 809D for cited deficiencies.


LPA Eivazian informed Andrea Ventrua, director that this report dated 03/14/2022 documents one Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care. Also, LPA Eivazian informed the director, Andrea Venture to provide a copy of this licensing report dated 03/14/2022 that documents one Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. The Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the Andrea Ventura, director at 12:10 p.m..

REPORT END 1 of 1
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2022
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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Document Has Been Signed on 03/14/2022 12:02 PM - It Cannot Be Edited

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: GLENDALE MONTESSORI SCHOOL
FACILITY NUMBER: 191201813

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/15/2022
Section Cited

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101170(e) (1): Criminal Record Clearance--All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: Obtain a California clearance or a criminal record etc... This requirement was not met as evidenced by...
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On 03/14/2022 during a tour of the facility LPA Eivazian observed staff#1 who was present in Room A did not have finger print clearance in Licensing Information System (LIS).
This poses an immediate health and safety risk to the children in care.
$500 Civil Penalty was accessed.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3


Document Has Been Signed on 03/14/2022 12:02 PM - It Cannot Be Edited

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: GLENDALE MONTESSORI SCHOOL
FACILITY NUMBER: 191201813

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/15/2022
Section Cited

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101212 (1)(B)-- Reporting Requirements
Events reported shall include the following:
Any injury to any child that requires medical treatment.

This requirement was not met as evidenced by...
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Based on staff interviews on 03/14/2022, Child#1 hit child #2 on 03/03/2022 with a wooden block and child#2 sustained a small opening on the left side corner of the eye by the end of eyebrow line and this incident was not reported to licensing. This poses a potential health, safety and personal right risk to the children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2022
LIC809 (FAS) - (06/04)
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