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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198008821
Report Date: 04/05/2021
Date Signed: 04/05/2021 04:57:40 PM

Document Has Been Signed on 04/05/2021 04:57 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:AMISTAD PRESCHOOLFACILITY NUMBER:
198008821
ADMINISTRATOR:ANAHIT SHMAVONYANFACILITY TYPE:
850
ADDRESS:2037 N. LINCOLN PARK AVE.TELEPHONE:
(323) 441-8718
CITY:LOS ANGELESSTATE: CAZIP CODE:
90031
CAPACITY: 48TOTAL ENROLLED CHILDREN: 0CENSUS: 7DATE:
04/05/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:06 AM
MET WITH:Site Supervisor, Anahit ShmavonyanTIME COMPLETED:
02:44 PM
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On April 05, 2021 at 10:06 a.m., Licensing Program Analyst (LPA) Mireya García contacted the Site Supervisor, Anahit Shmavonyan via telephone due to COVID 19 and precautionary measures in order to conduct a Case Management inspection due to an incident that was reported to the Department on March 25, 2021. LPA Garcia discussed the purpose of the call and conducted this inspection with Site Supervisor, Anahit Shmavonyan. At 10:08 am., the call was transferred into a FaceTime tele-inspection. During this tele-inspection, Site Supervisor, took LPA García on a virtual tour of the facility. There were seven (7) day care children present in classroom #2.

On March 25, 2021, an incident was self reported to the Department via telephone by the facility who reported a parent alleges that child's personal rights were violated while in care. The purpose of the tele-inspection was to obtain additional information regarding the allegation reported to the Department. During the tele-inspection, LPA conducted interviews. LPA was unable to complete interviews with all of the staff on this date due to staff not being present. Due to insufficient information available at this time, a follow up visit will be required at a later date.

REPORT CONTINUES ON NEXT PAGE 1 OF 2.
Brandi VanOosten
Mireya Garcia
DATE: 04/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/05/2021
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 2
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: AMISTAD PRESCHOOL
FACILITY NUMBER: 198008821
VISIT DATE: 04/05/2021
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A Notice of Site Visit was not provided to Site Supervisor, Anahit Shmavonyan since a physical inspection was not conducted.

Exit interview was conducted with Site Supervisor, Anahit Shmavonyan via tele-inspection, during which Appeal Rights were verbally explained to Site Supervisor. A copy of this report (LIC 809) has been signed by LPA García. This report, along with a copy of the Appeal Rights (LIC 9058) will be scanned via e-mail to Site Supervisor, Anahit Shmavonyan, who understands that an electronic “Read Receipt” and/or confirmation of receipt of the e-mail confirms receipt of the report and constitutes an electronic signature. The facility representative was provided with the mailing address to the Monterey Park Regional Office (1000 Corporate Center Drive, Suite 200B, Monterey Park, CA 91754) and agrees to send a copy of the signed LIC 809 reports by email to LPA Garcia and mail originals forms to the office (Attention: LPA Garcia #2503).


END OF REPORT: PAGE 2 OF 2

SUPERVISOR'S NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2021
LIC809 (FAS) - (06/04)
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