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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197401262
Report Date: 11/22/2022
Date Signed: 11/22/2022 12:44:58 PM


Document Has Been Signed on 11/22/2022 12:44 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:C & E MERDINIAN ARMENIAN EVANGELICAL SCHOOLFACILITY NUMBER:
197401262
ADMINISTRATOR:MARIJAN KEVORKIANFACILITY TYPE:
850
ADDRESS:13330 RIVERSIDE DRIVETELEPHONE:
8189078149
CITY:SHERMAN OAKSSTATE: CAZIP CODE:
91423
CAPACITY:74CENSUS: 49DATE:
11/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
07:39 AM
MET WITH:Dr. Souzy Ohanian, Principal TIME COMPLETED:
12:55 PM
NARRATIVE
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On 11/22/2022 7:39 AM, Licensing Program Analyst (LPA), Denise Miranda conducted a continuation visit for the purpose of completing the required - 1 year inspection. LPA met with Dr. Souzy Ohanian, Principal and informed the purpose of this visit. Facility does not a Director since 08/2022.
LPA was guided and toured the facility indoors and outdoors. Days and hours of operation are Monday-Friday 8:00 AM – 3:30 PM.
LPA observed 49 children with 7 Staff. All children are under supervision, including visual supervision, of a teacher at all times. Capacity and limitations as specified on the license are being maintained. LPA observed 4 licensed preschool classrooms on the premises.

LPA reviewed a sample of children’s files and observed files were not complete. LPA reviewed Staff files Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have received a criminal record clearance or exemption. LPA reviewed a sample of staff files and observed files were not complete.


LPA obtained a copy of Sign in and Out dated today and LIC500 Personnel Records.
During this inspection, LPA observed that Facility removed all poisons (such as Clorox, lotions and other products) that were accessible to the children in care in classrooms. LPA observed that Facility keep all these products inside of cabinets (top cabinets), making them inaccessible to the children in care. Plan of correction letter was provided during this inspection.
Staff interview conducted and documented at 10:19AM.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:
DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/22/2022
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 4


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: C & E MERDINIAN ARMENIAN EVANGELICAL SCHOOL
FACILITY NUMBER: 197401262
VISIT DATE: 11/22/2022
NARRATIVE
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On 11/16/2022 and 11/22/2022, LPA advised and provided consultation to the Administrator and Principal to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

On 11/17/2022 LPA sent an email and provided a copy of the Effects of Lead Exposure form during the inspection and discussed the following Provider Information Notices (PINs) Required Lead Testing: PIN 20-01 CCP Effects of Lead Exposure, and Guardian User Account Access - PIN 20-20-CCLD.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiency is being cited: (see next page, LIC809 D).

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided, along with copy of the report, and appeal rights and required to be posted for 30 days.

Exit interview conducted, appeal rights were explained, and report was reviewed with Principal Dr. Souzy Ogahian.

SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4
Document Has Been Signed on 11/22/2022 12:44 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: C & E MERDINIAN ARMENIAN EVANGELICAL SCHOOL
FACILITY NUMBER: 197401262

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/22/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, and record review, the licensee did not comply with the section cited above of 7 staff do not have immunization record availalble, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/22/2022
Plan of Correction
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Principal agreed to submit copies to LPA Miranda via email of the proof immunization record (perstusis, measles(MMR), and influenza for the seven staff. The immunization for influenza staff can provide a waiver letter no later than 12/22/2022.
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above in 6 of the 7 staff file reviewed, facility was unable to produce copy of the health screening with tb test results which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/22/2022
Plan of Correction
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Principal agreed to submit copy of the health screening, including a test for tuberculosis, no later thant 12/22/2022 for the 6 staff via email to LPA Miranda.

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: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:
DATE: 11/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/22/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4


Document Has Been Signed on 11/22/2022 12:44 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: C & E MERDINIAN ARMENIAN EVANGELICAL SCHOOL
FACILITY NUMBER: 197401262

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/22/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101220(a)
Child's Medical Assessments
(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation,interview and record review, the licensee did not comply with the section cited above in 5 files reviewed, 5 children do not have the medical assessment of the child on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/22/2022
Plan of Correction
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Principal agreed to submit a copy of the medical asseesment of the child (#1,#2, #3,#4 and #5) via email to LPA Miranda no later thant 12/22/2022.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:
DATE: 11/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/22/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4