<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198004486
Report Date: 06/06/2019
Date Signed: 06/06/2019 10:01:06 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: 42DATE:
06/06/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Teacher Anahit PapazyanTIME COMPLETED:
10:15 AM
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
Licensing Program Analyst conducted an unannounced case management inspection on this date for the purpose of citing deficiencies. Upon arrival LPA met with Teacher Anahit Papazyan, as Director Angela was not yet in the facility. LPA toured the facility and observed a total of 42 children children and 5 staff.

On 10/16/18, the Department received a complaint regarding allegations of personal rights. Throughout the investigation conducted by LPA, interviews were conducted, police records were obtained, and camera footage was reviewed. During the investigation LPA determined that other violations not related to the complaint occurred.

LPA obtained police records and copies of camera footage from the Glendale Police Department. Based on camera footage, LPA observed that during naptime child #1 can observed being pulled back by their legs onto their napping cot, swatted on the bottom, and then their foot being stepped on by Staff #1 (no longer in the facility). Later in the video, Staff #1 approaches child #2 and grabs the child’s ear. The child attempts to pull away and child falls onto their napping cot. The child is seen holding their ear, when Staff #1 grabs the child’s other ear and forces the child down onto their mat. Staff #2 (no longer in the facility) is noted as being the other staff in the room during the time.

SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Ariel AlmazanTELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MONTESSORI ACADEMY
FACILITY NUMBER: 198004486
VISIT DATE: 06/06/2019
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
Based on interview LPA conducted with Staff #2, Staff #2 disclosed observing personal rights violations in the facility by staff but failed to report it to the Department or law enforcement at the time the violations were observed. The facility will be cited for violating reporting requirements.

Based on information obtained during the complaint investigation, LPA determined that child #3 sustained an injury to their mouth and lips at the facility but it was not observed by any staff nor reported to the parent. Based on this, the facility will be cited for lack of supervision.

Upon receipt of this report, the Licensee shall post the Notice of Site visit and any licensing report documenting a type “A” deficiency. The report and the Notice of Site visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit. A copy of the Parent Notification Requirements was also provided to the licensee.

See attached deficiencies page for citations in accordance with Title 22 California Code of Regulations. Exit interview conducted with Teacher Anahit Papazyan. A copy of this report and appeal rights were provided and explained.

SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Ariel AlmazanTELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: 06/06/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/06/2019
Section Cited
CCR
101212(d)
1
2
3
4
5
6
7
Reporting Requirements
(d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information
1
2
3
4
5
6
7
Teacher will relay information to the director.
8
9
10
11
12
13
14
specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.
This requirement was not met as evidenced by Staff #2's disclosures of obvserving staff in the facility violate the personal rights of children. This poses an immediate risk to the health and safety of children in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: 06/06/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: 06/06/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/06/2019
Section Cited
CCR
101223(a)(3)
1
2
3
4
5
6
7
Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights: (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions
1
2
3
4
5
6
7
Teacher will relay information to the director.
8
9
10
11
12
13
14
of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.
This requirement was not met as evidenced by LPA's observations of camera footage revealing Staff #1 violating personal rights of 2 children in care. This poses an immediate risk to the health and safety of children in care.
8
9
10
11
12
13
14
Type A
06/06/2019
Section Cited
CCR
101229(a)
1
2
3
4
5
6
7
Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision as necessary to meet the children's needs.
This requirement was not met as evidenced by LPA's conducted interview with Staff #2 who did not observe how Child #3 was injured while
1
2
3
4
5
6
7
Teacher will relay information to the director.
8
9
10
11
12
13
14
under their care and supervision.
This poses an immediate risk to the health and safety of children in care.
8
9
10
11
12
13
14
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: 06/06/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4