191225746-2-17-2022-30-CC-DLOE-CBQTGP-20220217134328

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191225746
Report Date: 02/17/2022
Date Signed: 02/17/2022 01:43:33 PM

Document Has Been Signed on 02/17/2022 01:43 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	HOLY MARTYRS ARMENIAN PRESCHOOL.		FACILITY NUMBER:	191225746
ADMINISTRATOR:	VEHANOUSH GABRIELIAN		FACILITY TYPE:	850
ADDRESS:	16617 PARTHENIA STREET		TELEPHONE:	(818) 892-9540
CITY:	SEPULVEDA	STATE: CA	ZIP CODE:	91343
CAPACITY:	177	CENSUS: 109	DATE:	02/17/2022
TYPE OF VISIT:	Case Management - COVID-19	UNANNOUNCED	TIME BEGAN:	11:55 AM
MET WITH:	Vehanoush Gabrielian		TIME COMPLETED:	01:55 PM

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

On 02/17/2022 at 11:55 am, Licensing Program Analyst (LPA) Deborah Lowe conducted an unannounced Case Management – COVID-19 inspection for the purpose of following up on 4 Unusual Incident Reports (UIR) submitted on 01/24/2022, 01/26/2022, 01/27/2022, and 02/04/2022. LPA Lowe met with Director, Vehanoush Gabrielian, who toured LPA through the inside and outside of the facility. LPA observed 109 children in care with 17 staff. Staff present were observed to have their criminal record clearances.

According to the UIR, on 01/24/2022 - 2 children were reported as testing positive for COVID-19.

According to the UIR, on 01/26/2022 – 3 children were reported as testing positive for COVID-19.

According to the UIR, 01/27/2022 – 2 staff members were reported as testing positive for COVID-19.

According to the UIR, 02/04/2022 – 1 staff member was reported as testing positive for COVID-19.

Director stated all of the children and staff who were reported positive COVID have all isolated and have since all returned to the facility. LPA Lowe observed 4 out of 5 children who were reported with positive COVID to be in attendance during visit, with 1 of the children absent. LPA Lowe observed 3 staff who were reported with positive COVID to be in attendance during visit.

During visit LPA Lowe observed the children napping within the classrooms. LPA observed children’s masks in cubbies, staff wearing masks, soap and paper towels were observed to be available at all handwashing sinks and hand sanitizer available in each room.. Masks in child’s cubbies were observed as having been used.

Entrance of facility has tables set up for sign in/ out. LPA Lowe observed sign in/out sheets to have parent/ guardians full signature. At sign in/out tables LPA observed a box of children’s masks, thermometers, container labeled clean pens, container labeled soiled pens, and hand sanitizer.

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (434) 301-3069
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: HOLY MARTYRS ARMENIAN PRESCHOOL.	FACILITY NUMBER: 191225746
	VISIT DATE: 02/17/2022

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
26
27
28
29
30
31
32

LPA Lowe observed COVID-19 signage throughout the facility for mask wearing, washing hands, and stay safe 6 feet apart. At the front entrance LPA Lowe observed signs advising, “If you have a fever, cough, shortness of breath or have been exposed to someone with COVID-19 Please Do Not Enter the Building” and “Stop, No Visitors Allowed Due to COVID-19.

LPA Lowe observed facility supply of PPE COVID supplies as gloves, gowns, hand sanitizing wipes, liquid hand sanitizer, cleaning wipes, children mask, adult masks, and thermometers.

LPA Lowe discussed with Director current COVID-19 resources and guidance.

No deficiencies are cited, per Title 22, Division 12, Chapter 3, of the California Code of Regulations.

An exit interview was conducted and a copy of this report (LIC 809) and Notice of Site Visit were provided to Director, Vehanoush Gabrielian.

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (434) 301-3069
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2022

LIC809 (FAS) - (06/04)

Page: 2 of 2