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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198004486
Report Date: 05/16/2022
Date Signed: 05/16/2022 10:39:20 AM


Document Has Been Signed on 05/16/2022 10:39 AM - 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, 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) 841-9096
CITY:GLENDALESTATE: CAZIP CODE:
91201
CAPACITY:85CENSUS: 21DATE:
05/16/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Asmik Mavushyan, TeacherTIME COMPLETED:
10:50 AM
NARRATIVE
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Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced case management inspection to the above facility on 05/16/2022. LPA arrived at the facility at 9:50 AM and met with Asmik Mavushyan, teacher who guided analyst on a tour of the facility. During this inspection licensee/director Niranjala Bibile was not present in the facility. During this inspection there were 21 children present in the facility with three staff.

Alleged Incident took place on 11/10/2021, however it was reported to the school on 11/15/2021. Incident was reported via telephone on 11/15/2021. The facility reported the incident within the required 24 hour time frame.

Based on an interview that was conducted with staff#4, per staff#3 on 11/10/2021 child#1 came in the school in the morning, was playing with Lego inside the classroom, and then hit another child with a Lego, at that time staff#3 said no no to child#1 and removed child#1 from that group to another area. When staff#1 arrived asked why child#1 was on different table. Per staff#4, staff#1 and staff #3 had a discussion that child#1 was a special need child and needs a shadow. Per staff#4, all the conversation was taped and child#1 had a recording tape in pocket on 11/10/2021 from 8:30 a.m. to 12:00 p.m..

Based on interviews that were conducted with staff#1, staff#2, and staff#3 no disclosures were made. Per staff#3, on 11/10/21, child#1 came to the classroom in the morning with staff#3. Child#1 went from table area to the carpet area and pushed Lego on child#2’s face and staff#3 went to child#1. Per staff#3, child#1 was observed before to throw stuff around and thought was playing. At that time staff#3 went to child#1 and brought child#1 and gave materials and continued the day. Per staff#3 when staff#1 came, staff#3 informed staff#1 that child#1 pushed Lego on child#2’s face and staff#1 took child #1 in their classroom.
REPORT CONTINUES ON NEXT PAGE 1 of 2
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2022
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 3


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: 05/16/2022
NARRATIVE
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On 03/01/2022 LPA Eivazian heard the first hour an half of recording from 11/10/2021. LPA heard staff#1 and staff#3 were talking in a proper way with other children, however LPA heard staff#1 and staff#3 talked inappropriate to child#1. LPA heard staff#3 stated in Armenian and not in a pleasant tone: “ I do not give it to you, go hit, do you like someone hit you, then teacher said, go say sorry. Sit here, No, sit with me, do not touch anything. I am not letting you to hurt others!”. Staff#3 stated to child#1 in Armenian: “Sit here, why do you touch. I will bright the vacuum. Sit here, Do not touch it”. Staff#3 stated in Armenian: “ child#1 come, I told you fix this, do not touch it, that is not yours, that is not for you, your mom said you are smart, I am not seeing you are smart, I am not surprised why teacher said that”. LPA heard staff#1 stated to child#1 in Armenian: “where are you going, I will be so strict with you”. Staff#1 stated to Child#1 in Armenian and angry tone: “what are you doing? Sit down on your place? Do not move. Sit down, sit if not I will take you to the kitchen. LPA Eivazian heard in recording staff#1 stated to child#1 in Armenian “sit down, eat right now, if not I will bring the vacuum and turn it on under your ear”. LPA heard child#1 stated no, no, no.

The following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

LPA Eivazian informed facility representative, teacher Asmik Mavushyan that this report dated 05/16/2022 documents 1 Type A citation. Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Eivazian informed the facility representative, teacher Asmik Mavushyan to provide a copy of this licensing report dated 05/16/2022 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

The Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the facility representative, Asmik Mavushyan at 10:50 a.m..

REPORT END 2 of 2
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 05/16/2022 10:39 AM - 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
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: 05/16/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/17/2022
Section Cited

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101223 (a) (1)-- Personal Rights-- To be accorded dignity in his/her personal relationships with staff and other persons.

This requirement was not met as evidenced by:

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On 03/01/2022 LPA Eivazian heard the first hour an half of recording from 11/10/2021. LPA heard staff#1 and staff#3 were talking in a proper way with other children, however LPA heard staff#1 and staff#3 talked inappropriate to child#1. This poses an immediate health/safety and personal right risk to the children in care.
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LPA requested a declaration in writing to be submitted to LPA by plan of correction due date, 05/17/2022.

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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: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3