198004486-11-18-2022-33-CC-AEIN-CLAU5V-20221118141723

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198004486
Report Date: 11/18/2022
Date Signed: 11/18/2022 02:18:06 PM

Document Has Been Signed on 11/18/2022 02:18 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	MONTESSORI ACADEMY		FACILITY NUMBER:	198004486
ADMINISTRATOR:	BIBILE, NIRANJALA		FACILITY TYPE:	850
ADDRESS:	1920 W. GLENOAKS BOULEVARD		TELEPHONE:	(818) 841-9096
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91201
CAPACITY:	85	CENSUS: 20	DATE:	11/18/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Bibile Niranjala, Director		TIME COMPLETED:	02:40 PM

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 (LPA) Anomeh Eivazian conducted an unannounced annual inspection on 11/18/2022 at 8:45 AM. Upon LPA's arrival to the facility director was not present in the facility. LPA met with Asmik Movushyan, Teacher. LPA waited in the classroom by the entrance door till 10:45 a.m. when director, Bibile Niranjala arrived and guided LPA on a tour of the facility. LPA provided Bibile Niranjala, director with a copy of the Entrance Checklist for Child Care Centers form (LIC 125). This is a preschool program located in the St Matthew's Lutheran Church property. The preschool program operates Monday – Friday from 6:30 AM – 6:00 PM. Upon LPA's arrival to the facility LPA observed 5 children were outside on the playground with staff#2. LPA went inside the classroom and observed 9 children with staff#1 doing exercises. At 9:15 a.m. and 9:20 a.m., two children came inside the classroom by the entrance door alone without a teacher supervision, put their bags in their cubbies alone, went to the bathroom and washed their hands on their own and then joined teacher Asmik Movushyan classroom. At this time Teacher Asmik Movushyan was in the second classroom which is separated by the dividers and she did not notice two children came inside the classroom. Also, Teacher Joeliza Danjana who received two children outside did not communicate with teacher Asmik Movushyan that they are coming inside. Two children were unsupervised at 9:15 a.m. and 9:20 a.m. from the time they entered the classroom, washed their hands and then joined teacher Asmik Movushyan classroom. All areas identified on the Facility Sketch were inspected. Upon arrival, the following staff were present during this inspection: Staff #1 with 11 preschoolers in classroom (3.5-6 years old) classroom, staff#2 with 9 preschoolers (2-3.5 years old) outside on the outdoor playarea playing. The facility was observed to be within the license capacity and limitations. Staff names were recorded. The following was observed during the tour of the facility: REPORT CONTINUES ON NEXT PAGE 1 OF 4

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022

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
	VISIT DATE: 11/18/2022

NARRATIVE

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PHYSICAL PLANT: LPA observed the facility to be clean, safe, sanitary and in good repair. Furniture and equipment was inspected for age appropriateness and good repair, free of sharp, loose, or pointed parts. All indoor classrooms were inspected to ensure that the floors have a surface that is safe and clean. All materials accessible to children were observed to be toxic-free. Telephone service, heating, lighting and ventilation were evaluated. Children have their own cubby to store their belongings. On 11/18/22 at 10:15 a.m. LPA observed (2-3.5 year old ) classroom children took out their jackets outside and put it on top of each other and left it on the bench outside the classroom. (pictures were taken).Parents take Linens home each week on Friday or as needed and return it on Monday. Napping equipment (cots) were observed to be stored in the classroom. Age appropriate sinks and toilets were inspected for availability and good repair in all restrooms. General sanitation was observed. Availability of indoor drinking water was observed in the classroom. LPA observed water pitcher a disposable cups in the classroom.

Disinfectants, cleaning solutions, medication, and other items that are dangerous to children, were inaccessible to children. Per director, states there are no poisons stored at the facility. Director tested the carbon monoxide detectors in the kitchen. It sounded off the alarms and heard by LPA to be functional. LPA observed required posting information were posted in the hallway.

All kitchen areas/food preparation areas and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair. Trash cans used to discard food have tight fitting lids or solid waste bags shall be discarded immediately after each meal.

School has two outdoor playgrounds. One is located in the front yard which has grass area and one playground is located in the back of the building. Outdoor playground equipment is not in a safe condition, free of sharp, loose or pointed parts. LPA observed accessible rose bushes and cactuses in the front outdoor playarea. The surface of the outdoor activity space is not maintained in a safe condition and is not free of hazards. LPA observed in front outdoor playarea some areas that grass did not cover the ground and ground was not level which can be a tripping hazard. All areas around or under high climbing equipment, slides, and similar equipment are cushioned with sand and grass cushioning material that absorbs a fall; climbing apparatuses are single level only. There is adequate shade in the play yard. Availability of outdoor drinking water was observed. Per director, children use their water bottles during outdoor playtime. LPA advised that no children shall be left without the supervision of a teacher at any time.

REPORT CONTINUES ON NEXT PAGE 2 OF 4

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022

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
	VISIT DATE: 11/18/2022

NARRATIVE

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The Director states that there are no bodies of water on the premises and LPA did not observe any bodies of water during this inspection. Director states there are no weapons or firearms on the premises.

FACILITY RECORDS

Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
Children’s Records were reviewed for completeness; Inspection of required forms was made and documented on the LIC 857.

There is at least one person trained in CPR and Pediatric First Aid present during this inspection. However staff#2 who is the opening teacher does not have a current Pediatric First Aid and CPR. LPA also reviewed staff records. The review of Staff records was documented on the LIC 859. Staff#2 and staff #4 did not have proof of the AB 1207 Mandated Reporter Training certificate on file. Staff present had proof against TB, measles, pertussis, and influenza. All staff have been given on the-job training sanitation principles, housekeeping, including universal health precautions. Staff #2 and staff #3 did not have health screening from on file.

Children's roster was reviewed and is current. Sign in and out sheets were reviewed to ensure that the person who signs the child in and out uses their full legal signature and records the time of the day. LPA observed sign in/out sheet was placed outside by the entrance door. During this inspection 20 children were present, and all 20 children were singed in. Disaster drill log was available, last drill was conducted on 10/03/22.

Menus are posted one week in advance where it is visible by the child's authorized representative. Menus for the past 30 days are available upon request. Snacks were reviewed for availability, quantity and appropriateness to children in care. Preschoolers bring their own lunch and snacks from home. Facility provides optional AM and PM snack.
First Aid supplies were observed in each classroom. According to director facility does not administer any medication to children at this time. The facility was observed to be equipped with an isolation area for any child who becomes ill and it is located in the staff office. The ill child will use the staff restroom during isolation which is disinfected immediately after use per Site Supervisor.

REPORT CONTINUES ON NEXT PAGE 3 OF 4

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022

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
	VISIT DATE: 11/18/2022

NARRATIVE

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Medication: Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA advised the licensee to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.
To improve the quality and value of the new inspection process, a survey will be sent to the email address provided.
Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809D for deficiencies that are being cited and need to be cleared to protect the children’s health & safety.
LPA Eivazian informed director, Bibile Niranjala that this report dated 11/18/2022 document(s) 1 Type A citation Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.
Also, LPA Eivazian informed the director, Bibile Niranjala to provide a copy of this licensing report dated 11/18/2022 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.
A notice of site visit 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 director, Bibile Niranjala at 2:40 p.m..

END OF REPORT PAGE 4 OF 4

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 11/18/2022 02:18 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
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: 11/18/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

101229(a)(1)

Responsibility for Providing Care and Supervision

(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA's observation on 11/18/22 at 9:15 a.m. and 9:20 a.m. two children walked in the classroom alone, went to the bathroom alone and then joined teacher Asmik's class, the licensee did not comply with the section cited above and two children were observed without the supervision of a teacher from the time they entered the classroom, went to the bathroom and then joined the classroom which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 11/21/2022
	Plan of Correction
1 2 3 4	Per director, she will have a meeting with current teachers and all children will be together with two teachers early in the morning until the third teacher arrives in order to ensure all the children are under supervision of an adult all the times. A written statement will be submitted to LPA by 11/21/22.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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 Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 11/18/2022 02:18 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
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: 11/18/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101238.2(d)(1)

Outdoor Activity Space

(d) The surface of the outdoor activity space shall be maintained: (1) In a safe condition for the activities planned. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA's observation on 11/18/22 the licensee did not comply with the section cited above and LPA observed in front outdoor playarea some parts of the grass are gone and the ground is not even which is not safe for children and can be a tripping hazards. Also there are some rose bushes and cactuses in the front outdoor playarea accessible to the children which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/16/2022
	Plan of Correction
1 2 3 4	Per director, children will start to use the back outdoor playarea at this time until the front outdoor playarea be safe for children.

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on staff files review, the licensee did not comply with the section cited above and staff#2 and staff #4 did not have current mandated reporter training on file which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/16/2022
	Plan of Correction
1 2 3 4	Per director, staff#2 and staff#4 will complete required mandated reporter training by plan of correction due date and certificates will be submitted to LPA by 12/16/22.

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 Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022

LIC809 (FAS) - (06/04)

Page: 5 of 8

Document Has Been Signed on 11/18/2022 02:18 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
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: 11/18/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101216(g)(2)

Personnel Requirements

(2) Each person specified in (g) above shall have a health-screening report signed by the person performing the screening. This report shall indicate the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on staff files review, the licensee did not comply with the section cited above and staff#2 and staff#3 did not have required Health Screening form on file which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/16/2022
	Plan of Correction
1 2 3 4	Per director, staff #2 and staff #3 will complete required health screening by plan of correction due date and copies will be submitted to LPA by 12/16/22.

Type B

Section Cited

CCR

101238.4(a)

The licensee shall ensure that each child has an individual permanent or portable storage space for his/her clothing, personal belongings and/or bedding. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA observation at 10:15 a.m., the licensee did not comply with the section cited above and LPA observed (2-3.5 year old ) classroom children store their jacket on top of each other on the bench outside the classroom (picture was taken) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/16/2022
	Plan of Correction
1 2 3 4	Per director , each child has a storage inside the classroom but director will have a meeting with staff to ensure children belonging to be stored properly. A written statement will be submitted to LPA by 12/16/22.

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 Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022

LIC809 (FAS) - (06/04)

Page: 6 of 8

Document Has Been Signed on 11/18/2022 02:18 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
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: 11/18/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101216(f)

(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on staff file reviews, the licensee did not comply with the section cited above and staff#2 who opens the school does not have a current pediatric first aid and cpr certificate on file which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/16/2022
	Plan of Correction
1 2 3 4	Per director, staff#2 will update her pediatric first aid and cpr training and a copy of certificate will be submitted to LPA by 12/16/22.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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 Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022

LIC809 (FAS) - (06/04)

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