191225566-10-4-2023-58-CC-AMOY-CWAU37-20231004151305

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191225566
Report Date: 10/04/2023
Date Signed: 10/04/2023 03:13:16 PM

Document Has Been Signed on 10/04/2023 03:13 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	MONTESSORI CHILDREN'S ACADEMIE		FACILITY NUMBER:	191225566
ADMINISTRATOR:	WAHEEDA HAMID		FACILITY TYPE:	850
ADDRESS:	2400 W. BURBANK BLVD.		TELEPHONE:	(818) 842-1812
CITY:	BURBANK	STATE: CA	ZIP CODE:	91506
CAPACITY:	82	CENSUS: 22	DATE:	10/04/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Angela Pogosyan, Director		TIME COMPLETED:	02:45 PM

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Licensing Program Analyst (LPA) Alicia Mooberry conducted an unannounced Required 1 year inspection. LPA met with Director Angela Pogosyan who guided analyst on tour of the facility. This is a preschool program serving up to 82 children. The facility operates Monday – Friday from 6:30 AM – 6:00 PM and offers a half day schedule (6:30am to 12:30pm). The entrance to the facility is locked and parents enter using a call system. Per Director, there are 24 children currently enrolled. The facility (indoor and outdoors) operates on the grounds of a church building, however the facility has completely separate operations. Licensee Nina Koulax arrived at approximately 11:00am.

LPA observed the following classroom ratios: Room 1-Pre K, 11 children and 2 staff ; Room 2 located in basement 11 children and 1 staff. LPA observed teacher-child ratios in compliance and staff have the required background clearances at this time.

LPA observed telephone service, heating, lighting and ventilation. Children have individual cubby storage for their belongings including blankets. Napping mats are stored appropriately with bedding removed. Parent provide sheets and blankets and are responsible for weekly laundering.

LPA observed filtered drinking water with cups readily available in the classrooms. Age appropriate restrooms, sinks and toilets were inspected for good repair, water temperature, toilet paper, safety and sanitation. All available toilets and sinks are in operable condition. The indoor classrooms have surfaces that appear to be clean and safe.

Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are locked and/or inaccessible. The facility has one or more functioning smoke detectors and carbon monoxide detectors that meet statutory requirements. LPA observed fire extinguishers in the hallway and classrooms Serviced Jan 3, 2023.

There are age appropriate toys, furniture and educational material for children to use. Page 1 - Report Continues

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MONTESSORI CHILDREN'S ACADEMIE	FACILITY NUMBER: 191225566
	VISIT DATE: 10/04/2023

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At 11:15am LPA reviewed sign in and sign out sheets, 1 out of 22 children present was not signed in, LPA reminded Director to ensure children are being properly signed in and signed out by the authorized representative.

The outdoor play area is enclosed and surrounded by the building and exit gates area at least five feet high. Areas around and under climbing equipment have mats to cushion a fall. All play equipment, toys, materials and surfaces accessible to children appear to be age appropriate and toxic free. LPA observed crack on the concrete and peeling stucco in play area which poses a potential health, safety or personal rights risk to persons in care.

Snack menus are posted at least one week in advance and are visible to an authorized representative. The facility provides AM and PM snacks and lunch is provided by parents of children in care. Snacks were reviewed for availability, quantity, expiration dates and appropriateness for children in care. LPA observed the snack storage area (kitchen) to be clean and sanitary. LPA informed Site Supervisor to constantly assess expiration dates on food items that are removed from original packaging. LPA observed trash receptacles have tight fitting covers.

There are first aid supplies in each classroom. Hazardous items including cleaning compounds are stored in inaccessible areas such as high cabinets and inaccessible office and kitchen cabinets.

Per Licensee there are currently no children that require medication. If needed, medication is labled and stored in the office inaccessible to children in care. The office is used as an isolation area for children who are ill and there is a mat available for children to rest.

LPA conducted a Children's Records Review for completeness and to ensure children have proper forms such as Identification and Emergency forms, Immunization records, Health History, Personal Rights, Parents Rights on file. The children's roster was available and current.

At approximately 11:30am Staff Records were reviewed to ensure the following: Criminal record clearance or criminal record exemption, education credits, current CPR/First Aid and health preventative practices, proof of immunization against pertussis and measles and influenza and/or flu declination, Mandated Reporter training, LPA observed the there are no staff member to have current EMSA approved CPR. The Director has current CPR/First aid that is not EMSA approved. This poses a potential risk to the safety of children in care. Page 2 - Report Continues

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MONTESSORI CHILDREN'S ACADEMIE	FACILITY NUMBER: 191225566
	VISIT DATE: 10/04/2023

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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/

Licensee was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA informed Director to log onto web site www.ccld.ca.gov to access forms, regulations and quarterly updates. Records for all children and staff must be maintained for three (3) years after separation from the facility. Report Unusual Incidents and/or injuries to the parent/guardian immediately and to Child Care Licensing within 24 hours and/or the next business day.

CCC DID NOT COMPLETE TESTING PRIOR TO THEIR DEADLINE. LPA referred licensee to the Department website for lead: Lead Toxicity Prevention and Water Testing Information. PIN 21-04-CCP and PIN 21-21.1-CCP

Deficiencies were cited today in accordance with California Code of Regulations, Title 22, Division 12

Chapter 1, See LIC 809D.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/tion-process.

Exit interview was conducted with Licensee, Nina Koulax and a copy of Appeal Rights (LIC 9058) was discussed and provided.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/04/2023 03:13 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
EL SEGUNDO CC NORTH, 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: 10/04/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above in that licensee has not tested the 2 operational water fountains in the children's playground as required which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/25/2023
	Plan of Correction
1 2 3 4	Per licensee and Director, the water fountatins are not used by the children. LPA observed 5 gallon containers of filtered water availabel for children to use. Labled water bottle are in the classroom that are filled with filtered drinking water. The Licensee will comply with the Written Directive and send proof of correction the department by POC due date.

Type B

Section Cited

CCR

101238.2(d)(2)

Outdoor Activity Space

(d) The surface of the outdoor activity space shall be maintained: (2) Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above in that there were crack on the concrete and peeling stucco in play area which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/11/2023
	Plan of Correction
1 2 3 4	Per licensee the outdoor playground and wall will be patched up and made safe, proof of correction will be sent to LPA by POC due date

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: Valarie Cook	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023

LIC809 (FAS) - (06/04)

Page: 4 of 5

Document Has Been Signed on 10/04/2023 03:13 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
EL SEGUNDO CC NORTH, 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: 10/04/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101216(f)

Personnel Requirements

(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in zero out of 5 staff pesent did not have EMSA approved Pediatric CPR/First Aid which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/18/2023
	Plan of Correction
1 2 3 4	Per Licensee, at least one staff member will complete the required EMSA approved Pediatric CPR/First Aid. Proof of completion will be sent to LPA by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Valarie Cook	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023

LIC809 (FAS) - (06/04)

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