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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191225566
Report Date: 05/04/2022
Date Signed: 05/05/2022 10:30:50 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/16/2022 and conducted by Evaluator Lisa Clayton
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20220316133227
FACILITY NAME:MONTESSORI CHILDREN'S ACADEMIEFACILITY NUMBER:
191225566
ADMINISTRATOR:WAHEEDA HAMIDFACILITY TYPE:
850
ADDRESS:2400 W. BURBANK BLVD.TELEPHONE:
(818) 842-1812
CITY:BURBANKSTATE: CAZIP CODE:
91506
CAPACITY:82CENSUS: 39DATE:
05/04/2022
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:NINA KOULAX, OWNERTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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NEGLECT/LACK OF SUPERVISION: Staff did not provide adequate supervision.
PERSONAL RIGHTS: Child was injured while in care.
INVESTIGATION FINDINGS:
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On 05/04/2022, LPA Clayton conducted an un-announced visit to deliver the findings of the above allegations. LPA was greeted by Owner Nina Koulax and the Director Angela Pogosyan. Also present were 6 teachers and 39 children in care.
LPA toured the facility for Health & Safety inspection, and observed children being handled and supervised appropriately.

It was alleged that a child sustained injuries while in care and that the staff didn't see what happened when the incident occured. Based on the information obtained and interviews conducted, the preponderance of evidence standard has been met, therefore, the allegations of LACK OF SUPERVISION AND PERSONAL RIGHTS are being SUBSTANTIATED. California Code of Regulation, Title 22, 101229(a)(1) and 101223(a)(2) being cited on the attached LIC9099D(s).
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Lisa ClaytonTELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 30-CC-20220316133227
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MONTESSORI CHILDREN'S ACADEMIE
FACILITY NUMBER: 191225566
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/04/2022
Section Cited
CCR
101229(a)(1)
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(a) The licensee shall provide care and supervision as necessary to meet the children's needs.
(1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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Licensee will ensure that staff is providing 100% visual supervision at all times when children in care are outside, implementing a plan for the staff to move areound while supervising, or to hire adeqaute number of staff.
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This requirement is not met as evidenced by:
Based on information obtained and interviews conducted, staff was unaware that a child was injured by another child(ren) while in care, which poses an immediate risk to the Health, Safety and Personal Rights of the children in care.
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Type B
05/04/2022
Section Cited
CCR
101223(a)(2)
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The licensee shall ensure that each child is accorded the following personal rights:
(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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Licensee will ensure that staff is providing 100% visual supervision at all times when children in care are outside, implementing a plan for the staff to move areound while supervising, or to hire adeqaute number of staff.
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This requirement is not met as evidenced by:
Based on information obtained and interviews conducted, staff was unaware that a child was injured by another child(ren) while in care, which poses an immediate risk to the Health, Safety and Personal Rights of 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: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Lisa ClaytonTELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2