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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494554
Report Date: 07/15/2021
Date Signed: 07/15/2021 03:49:38 PM

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:BURBANK MONTESSORI ACADEMYFACILITY NUMBER:
197494554
ADMINISTRATOR:KITHMINI CURRYFACILITY TYPE:
850
ADDRESS:217 N HOLLYWOOD WAYTELEPHONE:
8188488226
CITY:BURBANKSTATE: CAZIP CODE:
91505
CAPACITY:45CENSUS: 55DATE:
07/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Andria J. Martin, Head Lead Teacher and Jocelyn Duarte, Teacher TIME COMPLETED:
03:40 PM
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On 7/14/21 Licensing Program Analyst (LPA) Denise Miranda, conducted an unannounced Annual Required Inspection and was met by Teacher Assistant Ms. Jocelyn Duarte and Head Lead Teacher Ms. Andria J. Martin. During this inspection Director was present.

Also, Present were 9 additional staff, Days and hours of operation are Monday-Friday 8:00am-6:00pm.

LPA toured the facility inside and outside and a census was taken. Current facility sketch reviewed, and classrooms are being used today. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. All poisons are kept in a locked storage area. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are no stairs in this home. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (818) 848-8226.

There are currently no infants in care. LPA discussed Safe Sleep Regulations with licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area in the backyard is fenced and there are no hazards to children present. Capacity as specified on the license is 45 and was observed 55 children in care.

SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: BURBANK MONTESSORI ACADEMY
FACILITY NUMBER: 197494554
VISIT DATE: 07/15/2021
NARRATIVE
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LPA reviewed a sample of children’s files and observed files were complete with emergency information as required.

Director's Mandated Reporter Training was not available for review or for any staff. Staff#6 a pediatric CPR/First Aid it was completed on 08/14/2020. No staff’s and Director’s file was available for review. All adults who reside or work in the center have a criminal record clearance or exemption. There are no excluded individuals present at this Facility.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA, Lead Teacher and Teacher Assistant discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

During this inspection, LPA tour inside and outside of the facility and was observed that the number of children in care were 55 children. Facility was license for 45 children. Licensee has a Private School Affidavit Confirmation for 24 children (age 4 years and 9 months to 6 years old), however, LPA spoke over the phone with Licensee that stated the classroom # 1 is designated for the Private School Affidavit. The classroom# 1, makes part of the capacity of the preschool license, no waiver was found on file for private school use the outdoor space. Per licensee, no additional space is available on this premises for the private school, beside of the classroom#1.

SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: BURBANK MONTESSORI ACADEMY
FACILITY NUMBER: 197494554
VISIT DATE: 07/15/2021
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Per Title 22, Division 12, Chapter 3, of the California Code of Regulations 1 Type A and 3 type B deficiencies are cited.

The ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC9224) shall be signed and kept in each of the children’s records. LPA emailed a copy of this form to the licensee. The report shall be provided no later than the next business day or the next day the child is in care. LPA provided a copy of the form LIC9224.

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

SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: BURBANK MONTESSORI ACADEMY
FACILITY NUMBER: 197494554
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/15/2021
Section Cited

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A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation. This requirement is not met as evidenced by: Based on LPA observation, there were 55 children in care from the age group 2 to 6 years.

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This is a high health and safety risk to children in care.
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The LIC 9224 form shall be signed and kept in each of the children’s records. The report shall be provided no later than the next business day or the next day the child is 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: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2021
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: BURBANK MONTESSORI ACADEMY
FACILITY NUMBER: 197494554
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/16/2021
Section Cited

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Sign-in and out: The person who brings the child to, and removes the child from, the center shall sign the child in/out. This requirement is not met as evidenced by: Based on LPA review, only 49 parents sign in today the sign in-out sheet, that was observed with incomplete signatures or no names
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 Also, it was observed 55 ochildren in care. This is a potential health and safety risk to children in care.
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Type B
07/16/2021
Section Cited

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Personnel records: All personnel records shall be maintained at the child care center and shall be available to the licensing agency for review. This requirement is not met as evidenced by: Based on observation, the staff personnel records were not available to review. This is a potential health and safety risk to 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: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2021
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: BURBANK MONTESSORI ACADEMY
FACILITY NUMBER: 197494554
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/16/2021
Section Cited

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Health and Safety Code Section 1596.841 states:
Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, to the licensing agency upon request.and daytime telephone number of the child's
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 parent or guardian, and the name and telephone number of the child's physician. This roster shall be available. The requirement is not met as evidenced by Facility was not able to provide copy of the complete children's roster. This poses a potential health & safety risk to 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: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2021
LIC809 (FAS) - (06/04)
Page: 6 of 6