198004486-2-13-2024-33-CC-AEIN-D2EUX4-20240213145743

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198004486
Report Date: 02/13/2024
Date Signed: 02/13/2024 02:57:54 PM

COMPREHENSIVE INSPECTION

Document Has Been Signed on 02/13/2024 02:57 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: 15	DATE:	02/13/2024
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME BEGAN:	11:50 AM
MET WITH:	Niranjala Biblie, Licensee and Director		TIME COMPLETED:	03:15 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 Analysts (LPA) Anomeh Eivazian and Saul Valenzuela conducted an unannounced Required inspection on 02/13/24 at 11:50 AM. LPAs met with Niranjala Biblie, director who guided LPAs on a tour of the facility. An office meeting was held with licensee on 08/28/23 and facility was placed on required inspection for one year. 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. All areas identified on the Facility Sketch were inspected. Upon arrival, the following staff were present during this inspection: LPAs observed 14 children were having lunch in the kitchen area with two staff and one child was playing outside with one staff. Per director, currently there are two classrooms, preschool classroom (3.5- 6 years old), and preschooler classroom (2- 3.5 years old). 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: PHYSICAL PLANT: LPAs observed the facility to be clean, safe, sanitary and in good repair. Per director, cleaning crew cleans the facility daily after hours. 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. 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. LPAs observed water pitcher a disposable cups in the classroom. 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: 02/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024

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: 02/13/2024

NARRATIVE

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Disinfectants, cleaning solutions, medication, and other items that are dangerous to children, were inaccessible to children. Per director, there are two insect killers in the kitchen area in a high level cabinet out of reach of children. During this inspection, director stored two insect killers in her office closet and lock the door. Director tested the carbon monoxide detectors in the kitchen. It sounded off the alarms and heard by LPA to be functional. LPAs observed required posting information were posted in the hallway of entrance.

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 in a safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. 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. LPAs advised that no children shall be left without the supervision of a teacher at any time.

The Director states that there are no bodies of water on the premises and LPAs 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.

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: 02/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024

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: 02/13/2024

NARRATIVE

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Ten Children’s Records were reviewed for completeness; Inspection of required forms was made and documented on the LIC 857. Eight out of ten children were missing Physician Report, LIC 701.

There is at least one person trained in CPR and Pediatric First Aid present during this inspection. LPAs also reviewed four staff records. The review of Staff records was documented on the LIC 859. Staff#1 and Staff#4 did not have proof of immunization against measles, pertussis, and influenza. Staff#3 did not have health screening form LIC 503 on file. All staff have been given on the-job training sanitation principles, housekeeping, including universal health precautions.

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. LPAs observed sign in/out sheet was placed outside by the entrance door. During this inspection 15 children were present, and all 15 children were singed in. Disaster drill log was available, last drill was conducted on 01/24/24.

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 outside restroom during isolation which is disinfected immediately after use.

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

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: 02/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024

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: 02/13/2024

NARRATIVE

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Analyst reviewed new Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, which requires the testing of water for lead in Child Care Centers (CCCs) with facility director during the inspection. Per AB 2370, all CCCsthat are located in buildings constructed before January 1, 2010, must have their water tested and post the results by January 1, 2023, and every 5 years after the date of the first testing. Per director, Water Lead Testing was completed on 02/07/24. LPA obtained a copy of External Water Sampler Self Certification Form, LIC 9275 dated 02/07/24. Director will email LPA labeled facility sketch and final water lead testing report.

LPAs advised the licensee to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

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.

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 3:15 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: 02/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/13/2024 02:57 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: 02/13/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/13/2024 Section Cited CCR 101216(g)(2)	1 2 3 4 5 6 7	Personnel Requirements 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:	1 2 3 4 5 6 7	Per director, staff#3 will have required health screening form LIC 503 by plan of correction due date and a copy will be emailed to LPA Eivazian.
	8 9 10 11 12 13 14	Based on four staff files review, staff#3 did not have required Health Screening form on file which poses a potential health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14
Type B 03/13/2024 Section Cited HSC1597.622(a)(1)	1 2 3 4 5 6 7	General Provisions and Definitions Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Per director, she will have proof of immunization against measles, pertussis and influenza for staff#1 and staff#4 by 03/13/24 and copies will be emailed to LPA Eivazian.
	8 9 10 11 12 13 14	Based of four staff files review, staff#1 and staff#4 did not have proof of immunization against measles, pertussis and influenza on file. This poses a potential health, safety or personal rights risk to persons 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: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/13/2024 02:57 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: 02/13/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/13/2024 Section Cited CCR 101220(a)	1 2 3 4 5 6 7	Child's Medical Assessments (a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. etc... This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Per licensee, she will have Physician Report LIC 701 for 8 children by 03/13/24 and copies will be emailed to LPA Eivazian.
	8 9 10 11 12 13 14	Based on 10 children file review, 8 children did not have Physician Report LIC 701 on file. This poses a potential health, safety or personal right risk to the 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: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024

LIC809 (FAS) - (06/04)

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