191201813-6-18-2024-33-CC-AEIN-D6CP76-20240618110325

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191201813
Report Date: 06/18/2024
Date Signed: 06/18/2024 11:03:30 AM

Document Has Been Signed on 06/18/2024 11:03 AM - 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 SCHOOL		FACILITY NUMBER:	191201813
ADMINISTRATOR:	ANDREA VENTURA		FACILITY TYPE:	850
ADDRESS:	413 WEST DORAN		TELEPHONE:	(818) 240-9415
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91203
CAPACITY:	73	CENSUS: 0	DATE:	06/18/2024
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Andrea Ventura, Director		TIME COMPLETED:	11:20 AM

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	Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced case management inspection on 06/18/24 at 10:10 AM, due to an incident that occurred on Thursday, 05/30/24. LPA met with Andrea Ventrua, Director who guided analyst on a tour of the facility. During this inspection no children were present in the facility due to summer break. Alleged Incident took place on 05/30/24. Incident was reported via email same working day. Original LIC 624 Unusual Incident/Injury Report form was received by the Department within 7 days. The facility reported the incident within the required 24 hour time frame. LPA observed the area where alleged incident took place. Pictures were taken. LPA Eivazian conducted a phone interview with staff#1 while she was in the facility. Based on staff#1, on 05/30/24 during outside play time, child#1 and child #2 were playing in a little plastic playhouse on the sand area by swing area. Per staff#1, she was sitting right outside the playhouse. Child#3, came over staff#1, and said, child#1 and child#2 were using "bathroom words". Per staff#1, when she went to talk to child#1 and child#2, child#1 had pants and underwear down and child#2 had pants down, pretending to go to the bathroom. Per staff#1, child#1 and child#2 came out and staff#1 talked to them about appropriate behavior at school. Per staff#1, then she observed a small piece of feces outside the playhouse, in the planter area of playhouse. Per staff#1, she communicated regarding this incident with all three children parents. Per staff#1, she was right outside the playhouse but she did not observe when child#1 and child#2 pulled down their pants and when child#1 pooped on playhouse planter area. LPA issued the Confidential Names List (LIC 811) to the director during this inspection. The Confidential Names List documents the staff and children involved with the incident documented in this report. REPORT CONTINUES ON NEXT PAGE 1 OF 2

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024

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: GLENDALE MONTESSORI SCHOOL	FACILITY NUMBER: 191201813
	VISIT DATE: 06/18/2024

NARRATIVE

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Based on this information, the following deficiency listed on the attached LIC 809d is being cited in accordance with California Code of Regulations Title 22. Deficiency that is being cited need to be cleared to protect the children’s health & safety.

LPA Eivazian informed director, Andrea Ventura that this report dated 06/18/24 document(s) 1 Type A citation. Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Eivazian informed the director, Andrea Ventura to provide a copy of this licensing report dated 06/18/24 that documents any Type A citation(s) 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.

A notice of site visit 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 director, Andrea Ventura.

REPORT END 2 of 2

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/18/2024 11:03 AM - 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: 06/18/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Request Denied Type A 06/20/2024 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	101229(a)(1)-- Responsibility for Providing Care and Supervision (1) No child(ren) shall be left without the supervision of a teacher at any time, ... This requirement was not met as evidenced by...	1 2 3 4 5 6 7	Per director, there is a staff meeting on 06/20/24, and they will talk to staff about active supervision and situated in a way to observe all the kids on the playground and inside the playhouse.
	8 9 10 11 12 13 14	Based on unusual incident report dated 05/30/24, & staff#1 phone interview, child#1 and child#2, pulled down their pants while playing on playhouse and child#1 pooped on playhouse planter area and staff#1 did not observe it. This poses an immediate health, safety and personal right risks to the children in care.	8 9 10 11 12 13 14	A written letter along with staff sign in sheet will be submitted to LPA by 06/20/24.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024

LIC809 (FAS) - (06/04)

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