198015235-3-3-2022-33-CC-AEIN-CC6UZK-20220303150141

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198015235
Report Date: 03/03/2022
Date Signed: 03/03/2022 03:01:55 PM

Document Has Been Signed on 03/03/2022 03:01 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:	PENNSYLVANIA AVENUE MONTESSORI PRESCHOOL		FACILITY NUMBER:	198015235
ADMINISTRATOR:	VARDUHI HAREYAN		FACILITY TYPE:	850
ADDRESS:	3966 PENNSYLVANIA AVENUE		TELEPHONE:	(818) 231-5605
CITY:	LA CRESCENTA	STATE: CA	ZIP CODE:	91214
CAPACITY:	56	CENSUS: 28	DATE:	03/03/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Marita Mkrtichian, Assistant Director and Sondra Wise, 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 David Kurdoglyan conducted an unannounced annual inspection on 3/03/2022 at 8:30 AM. LPAs met with Marita Mkrtichian, Assistant Director. Shortly after, around 9:15 a.m. licensee/director Sandra Wise arrived to the facility. LPAs provided Sondra Wise, director with a copy of the Entrance Checklist for Child Care Centers form (LIC 125). Assistant director, Marita Mkrtichian guided LPAs on a tour of the facility. The preschool program operates Monday – Friday from 7:00 AM – 6:00 PM. There is an infant program on the premises with facility number 198015236. All areas identified on the Facility Sketch were inspected. LPAs observed the following staff were present during this inspection; Preschool (2-3 year old classroom): Staff#1 and Staff#2 with 9 preschoolers in the classroom, Staff#3 and Staff#4 with 20 preschoolers outside in the back outdoor playarea. Staff#5 was on her break. The facility was observed to be within the license capacity and limitations. Staff names were recorded. All children were observed to be under visual supervision of a teacher at all times. 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. 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 corner of each classroom. Age appropriate sinks and toilets were inspected for availability and good repair in all restrooms. There are two bathrooms in the hallway of entrance. There is a girls bathroom with 3 toilets and 3 sinks and boys bathroom with 2 urinals, 2 toilets and 3 sinks. General sanitation was observed. Availability of indoor drinking water was observed in the classroom. LPAs observed water pitchers and disposal cups in each classroom. Per assistant director , children also use their own water cups. 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: 03/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2022

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: PENNSYLVANIA AVENUE MONTESSORI PRESCHOOL	FACILITY NUMBER: 198015235
	VISIT DATE: 03/03/2022

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 no poisons stored at the facility. LPAs observed carbon monoxide detectors in the facility.

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.

Outdoor playground equipment is in a safe condition, free of sharp, loose or pointed parts. There are two outdoor play area designated for preschool program. 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, swings, 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, teachers take children water bottles outside in a tray. 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.
During this inspection staff#2, (2-3 years old classroom) teacher does not have criminal record clearance on file. During this inspection LPA Eivazian contacted the office and talked to support staff Telly Bilbrew who stated staff#2 was cleared and case was closed in November 2020. During this inspection director showed DOJ Applicant Fingerprint Responds letter and Request for livescan service form (LIC9163) to LPA Eivazian. LPA talked to LPM Gabelman and agreed to cite this violation as Type B citation and no civil penalty.

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: 03/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2022

LIC809 (FAS) - (06/04)

Page: 2 of 6

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: PENNSYLVANIA AVENUE MONTESSORI PRESCHOOL	FACILITY NUMBER: 198015235
	VISIT DATE: 03/03/2022

NARRATIVE

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Children’s Records were reviewed for completeness; Inspection of required forms was made and documented on the LIC 857. LPA reviewed 10 children's file during this inspection, and child#1, child#6, child#7, and child#10 were missing Physician Report, LIC701.

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. During this inspection there were 28 preschoolers present and all 28 children were signed in.

There is at least one person trained in CPR and Pediatric First Aid present during this inspection. LPA also reviewed staff records. The review of Staff records was documented on the LIC 859. Staff present had proof of the AB 1207 Mandated Reporter Training certificate on file, except staff#4, his Mandated reporter training certificate was expired on 09/2021. Staff#5 was missing Health Screening form (LIC503). 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. Children's roster was reviewed and is current. Disaster drill log was available, last drill was conducted on 2/02/2022.

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 are provided AM and PM snacks and hot lunch. Hot lunch is provided by outside catering.

First Aid supplies were observed in each classroom in a cabinet. According to director, medication is only administered to a child when accompanied with a doctor's note and is stored in the child’s classroom. 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.
LPAs discussed the safe sleep regulations with director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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: 03/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2022

LIC809 (FAS) - (06/04)

Page: 3 of 6

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: PENNSYLVANIA AVENUE MONTESSORI PRESCHOOL	FACILITY NUMBER: 198015235
	VISIT DATE: 03/03/2022

NARRATIVE

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Medication: This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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. Director was requested to submit a plan for Incidental Medical Services by 04/04/2022.

LPAs advised the director to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov. UPDATE: LPAs provided the director with a copy of the Effects of Lead Exposure form during the inspection and discussed the following Provider Information Notices (PINs) Required Lead Testing: PIN 20-01 CCP Effects of Lead Exposure, and Guardian User Account Access - PIN 20-20-CCLD.

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.
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 licensee director.

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: 03/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2022

LIC809 (FAS) - (06/04)

Page: 4 of 6

Document Has Been Signed on 03/03/2022 03:01 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: PENNSYLVANIA AVENUE MONTESSORI PRESCHOOL	FACILITY NUMBER: 198015235
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/03/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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 LPA Eivazian file review, the licensee did not comply with the section cited above 1 out of 5 staff, staff#4 did not have current required mandated reporter training. Staff#4 mandated reporter training was expired on 09/2021 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/31/2022
	Plan of Correction
1 2 3 4	Per director, staff#4 will complete the required mandated reporter training by plan of correction due date 03/31/22 and a copy will be submitted to LPA as proof of correction.

Type B

Section Cited

CCR

101170(d)

Criminal Record Clearance

(d) All individuals subject to criminal record review shall, be fingerprinted and sign a Criminal Record Statement (LIC 508 [Rev. 1/03]) under penalty of perjury. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA Eivazian file review, the licensee did not comply with the section cited above in 1 out of 6 staff, staff#2 did not have active and current criminal record clearance in licensing system which poses/posed a potential health, safety or personal rights risk to persons in care. During this inspection staff#2, (2-3 years old classroom) teacher does not have criminal record clearance on file. During this inspection LPA Eivazian contacted the office and talked to support staff Telly Bilbrew who stated staff#2 was cleared and case was closed in November 2020. During this inspection director showed DOJ Applicant Fingerprint Responds letter and Request for livescan service form (LIC9163) to LPA Eivazian. LPA talked to LPM Gabelman and agreed to cite this violation as Type B citation and no civil penalty.
	POC Due Date: 03/04/2022
	Plan of Correction
1 2 3 4	Per director, staff #2 will complete live scan fingerprint by closing business day 03/04/2022 and a copy of livescan form will be submitted to LPA Eivazian as proof of correction.

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: 03/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2022

LIC809 (FAS) - (06/04)

Page: 5 of 6

Document Has Been Signed on 03/03/2022 03:01 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: PENNSYLVANIA AVENUE MONTESSORI PRESCHOOL	FACILITY NUMBER: 198015235
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/03/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101220(b)

Child's Medical Assessments

(b) The medical assessment shall provide the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA's file review, the licensee did not comply with the section cited above in 1 from 5 staff file review , staff #5 did not have Health Screening from LIC 503 on file which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/31/2022
	Plan of Correction
1 2 3 4	Per director, Staff#5 will complete health screening form by plan of correction due date and a copy will be submitted to LPA.

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: 03/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2022

LIC809 (FAS) - (06/04)

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