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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015236
Report Date: 03/17/2022
Date Signed: 03/17/2022 02:01:10 PM


Document Has Been Signed on 03/17/2022 02:01 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 INFANT CAREFACILITY NUMBER:
198015236
ADMINISTRATOR:VARDUHI HAREYANFACILITY TYPE:
830
ADDRESS:3966 PENNSYLVANIA AVENUETELEPHONE:
(818) 231-5605
CITY:LA CRESCENTASTATE: CAZIP CODE:
91214
CAPACITY:20CENSUS: 10DATE:
03/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Sondra Wise, DirectorTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced annual inspection on 3/17/2022 at 8:30 AM. LPA met with Marita Monfared, assistant director and preschool head teacher. Shortly after Sondra Wise, Licensee/Director and Armand Wise, teacher arrived to the facility. LPA provided Sondra Wise with a copy of the Entrance Checklist for Child Care Centers form (LIC 125). Marita Monfared guided LPA on a tour of the facility. This is an infant program with Toddler Option, (12 infants and 8 Toddlers). There is also a preschool program on the premises with facility number 198015235. The Infant program operates Monday – Friday from 6:30 AM – 6:30 PM. There is a wavier on file to use outdoor playarea on staggered schedule between Infant and Toddlers.

All areas identified on the Facility Sketch were inspected. Upon arrival, the following staff were present during this inspection; Infant Room: 2 staff with 6 infants in infant classroom and one staff was present in the Toddler room with 4 toddlers. 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. During 03/03/2022 preschool annual inspection LPAs Eivazian and Kurdoglyan observed at 9:42 a.m. child#1 was napping in infant crib room alone without any adult supervision. All infants and teachers were outside on playarea at that time. The following was observed during the tour of the facility:

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. 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 toddler classroom. General sanitation was observed. Availability of indoor drinking water was observed in the classroom. LPA observed children's water bottles in the Toddler and Infant classrooms.
REPORT CONTINUES ON NEXT PAGE 1 OF 5
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:
DATE: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/17/2022
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 7


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 INFANT CARE
FACILITY NUMBER: 198015236
VISIT DATE: 03/17/2022
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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. LPA observed smoke and carbon monoxide detectors in the classrooms.

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. 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 grass cushioning material that absorbs a fall; climbing apparatuses are single level only. There is adequate shade in the play yard by a big tree. Availability of outdoor drinking water was observed. Per director, teachers take water bottles outside during outdoor playtime. LPA 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 LPA did not observe any bodies of water during this inspection. Director states there are no weapons or firearms on the premises.

Infant changing tables have a padded surface no less than one inch thick and are covered with washable vinyl or plastic and have raised sides at least three inches high. LPA observed one changing table in infant classroom and one changing table in toddler classroom. Toys were observed to be clean and safe. Infant napping equipment meets the requirements of 101439.1 (a) - (f). Indoor activity space for this infant program is physically separate from the other components at this facility, and meets the requirements of 101438.3 (a) - (e).

The facility is in compliance with the staff-infant ratios required in 101416.5 (a) - (e). A fully qualified teacher is directly supervising no more than 12 infants. Each aide is responsible for the direct care and supervision of a group of no more than four infants. Individual Feeding Plans were not on file for each infant that meets the requirements of 101427 (b)(1) - (5). Infant Needs and Services Plan are on file for each infant that meets the requirements of 101419.2 (a)-(b) and 101419.3 (a). Teachers present have proof of the required infant units on file and meet the qualification requirements of 101416.2 (a), (b), (c) and (g).

REPORT CONTINUES ON NEXT PAGE 2 OF 5
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2022
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: PENNSYLVANIA AVENUE MONTESSORI INFANT CARE
FACILITY NUMBER: 198015236
VISIT DATE: 03/17/2022
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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.

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.
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. 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. Sign-In and Sign-Out sheets were reviewed. During this inspection 10 children present were signed in. 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. Infants bring their own formulas and facility provides snacks. Toddlers are provided AM and PM snacks and hot lunch. Hot lunch is provided by outside catering or they can bring their own food from home.

First Aid supplies were observed in the kitchen. 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 director. Per director they have a changing table in the kitchen that when there is a sick infant or toddler who is needed to be changed they will take the changing table to the staff bathroom.

REPORT CONTINUES ON NEXT PAGE 3 OF 5
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2022
LIC809 (FAS) - (06/04)
Page: 3 of 7
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 INFANT CARE
FACILITY NUMBER: 198015236
VISIT DATE: 03/17/2022
NARRATIVE
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Per director states infants sleep in the crib room in infant classroom where they are constantly supervised. Appropriate sleeping arrangements and cribs were observed. (one crib for each infant in care was observed). Cribs or play yard did not hinder the entrance or exit from the sleeping space in crib room, mattresses shall be firm and covered with a fitted sheet that overlaps the underside so it cannot be dislodged. Cribs and play yards were observed to be free of loose articles and objects. No objects were observed to be hanging above or attached to the side of the crib. LPA did not observe any infants swaddled while in care. LPA observed children sleep sacks which children hands are free and can move their hands on the cribs. LPA advised the Licensee that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age. A copy of the LIC 9227 was provided to Licensee. LPA provided the licensee with a copy of A Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. LPA also consulted and explained Child Abuse Reporting, Never Shake a Baby, and Safe Sleeping practices.

LPA 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.



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
REPORT CONTINUES ON NEXT PAGE 4 OF 5
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2022
LIC809 (FAS) - (06/04)
Page: 4 of 7
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 INFANT CARE
FACILITY NUMBER: 198015236
VISIT DATE: 03/17/2022
NARRATIVE
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LPA advised the licensee to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov. UPDATE: LPA 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, UPDATED GUIDANCE FOR CHILD CARE PROVIDERS REGARDING CORONAVIRUS DISEASE (COVID-19)-- PIN 20-10-CCP. 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 licensee director, Sondra Wise that this report dated 03/17/2022 documents one Type A citation 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 to provide a copy of this licensing report dated 03/17/2022 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 licensee/director, Sondra Wise at 2:00 p.m..

END OF REPORT PAGE 5 OF 5
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2022
LIC809 (FAS) - (06/04)
Page: 7 of 7
Document Has Been Signed on 03/17/2022 02:01 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 INFANT CARE
FACILITY NUMBER: 198015236

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/17/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101429(a)(1)
Responsibility for Providing Care and Supervision for Infants
(1) Each infant shall be constantly supervised and under direct visual observation and supervision by a staff person at all times. Under no circumstances shall ANY infant be left unattended.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs Eivazian and Kurdoglyan observed on 03/03/2022 during Preschool Annual inspection, at 9:42 a.m., child#1 was napping in infant crib room alone without any adult supervision. All infants and teachers were outside on playarea at that time. The licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/18/2022
Plan of Correction
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Per licensee/director, she will have an adult present in the crib room all the times while an infant is sleeping. A written declaration will be submitted to LPA Eivazian by plan of correction due date, 03/18/2022.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: 03/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/17/2022
LIC809 (FAS) - (06/04)
Page: 5 of 7


Document Has Been Signed on 03/17/2022 02:01 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 INFANT CARE
FACILITY NUMBER: 198015236

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/17/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101429(a)(2)(B)
Responsibility for Providing Care and Supervision for Infants
(B) Staff shall physically check on sleeping infant(s) every 15 minutes and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA Eivazian observations and record review on 03/17/2022, the licensee did not comply with the section cited above and infant teachers did not document physically supervision of infants while sleeping every 15 minutes which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/18/2022
Plan of Correction
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Per director, staff have been supervising infants physically and visually all the times while sleeping but did not document it. Per director, as of 03/18/2022 staff will document their supervision of infants every 15 minutes.
A written plan will be submitted to LPA Eivazian by 03/18/2022.
Type B
Section Cited
CCR
101427(b)(3)(B)
Infant Care Food Services
(b) There shall be an individual feeding plan for each infant. (3) The plan shall include the following items: (B) Feeding schedule.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review that was completed by LPA Eivazian on 03/17/2022, the licensee did not comply with the section cited above and staff did not record each infant feeding schedule daily which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/18/2022
Plan of Correction
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Per director, staff will document each infant feeding schedule daily on daily log.
A written plan will be submitted to LPA Eivazian by 03/18/2022.

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: 03/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/17/2022
LIC809 (FAS) - (06/04)
Page: 6 of 7