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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191225746
Report Date: 12/13/2019
Date Signed: 12/16/2019 08:49:52 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:HOLY MARTYRS ARMENIAN PRESCHOOL.FACILITY NUMBER:
191225746
ADMINISTRATOR:VEHANOUSH GABRIELIANFACILITY TYPE:
850
ADDRESS:16617 PARTHENIA STREETTELEPHONE:
(818) 892-9540
CITY:SEPULVEDASTATE: CAZIP CODE:
91343
CAPACITY:177CENSUS: 125DATE:
12/13/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Madeleine Aslanian/Program CoordinatorTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Silva Garibyan arrived at the above facility to conduct a Case Management Incident inspection. The self - reported incident occurred at Holy Martyrs Armenian Preschool on 11/13/19. The El Segundo Regional Office received the incident report on 11/13/19. Upon arrival, LPA observed proper care and supervision. All center staff that was present during today’s inspection had fingerprint cleared and associated to the designated license number.

" On 11/13/19, at approximately 10;00 am., father brought child #1 to school for Picture Day. He informed the director, that child complained of earache after getting a bath and told father that he put something in his ear. Father took child to see an Ear Nose Throat specialist on 11/13/19 (same day). The child told teacher on 11/13/19 that on 11/12/19 he pulled a corn kernel off the corn cob located in the class and put it in his ear. "

The incident involves a possible lack of supervision issues.

LPA interviewed the program coordinator, teacher #1, and Child #1. At this time based on the available information it does not appear this incident was the result of a Title 22 violation.

The content of this report was read and discussed in detail at the time of the visit with the licensee.

An exit interview was conducted; the Notice of Site Visit must be posted for 30 days upon receipt.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2019
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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