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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198004486
Report Date: 05/01/2019
Date Signed: 05/07/2019 08:49:06 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:MONTESSORI ACADEMYFACILITY NUMBER:
198004486
ADMINISTRATOR:BIBILE, NIRANJALAFACILITY TYPE:
850
ADDRESS:1920 W. GLENOAKS BOULEVARDTELEPHONE:
(818) 846-5999
CITY:GLENDALESTATE: CAZIP CODE:
91201
CAPACITY:85CENSUS: 56DATE:
05/01/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:31 AM
MET WITH:Angela BibileTIME COMPLETED:
11:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Ariel Cazares conducted an unannounced case management inspection on this date for the purpose of clearing deficiencies cited on 10/25/18. There were 56 children and 6 staff present. Director was no in the facility upon arrival.

On 10/25/18, the facility was cited for not being in compliance with Teacher-Child Ratio and for not having a roster available. ON this date LPA observed compliance with ratios and the roster.

During inspection LPA observed staff #1 in the changing room with 6 children. LPA observed one child in a crib that has a fan, small play table, a play car structure, and a kid's toolbox in it. This crib was not clutter free and child was in between items. Child was not placed in a safe environment. LPA advised Staff #1 to remove child explaining that it was an unsafe setting for the child. Child was immediately removed. See 809-D for cited deficiencies.

Any report documenting a Type A must be given to parents/guardians of children enrolled.

Exit interview conducted with Director Angela. Notice of Site Visit Posted.

*Due to computer issue an electronic version of report could not be provided.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Ariel AlmazanTELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2019
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MONTESSORI ACADEMY
FACILITY NUMBER: 198004486
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/01/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/01/2019
Section Cited
CCR
101223(a)(2)
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The licensee shall ensure that each child is accorded the following personal rights:

(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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Per Director, will have a staff meeting and submit documentation to LPA by POC due date 5/8/19.
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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: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Ariel AlmazanTELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2019
LIC809 (FAS) - (06/04)
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