198016567-10-19-2023-58-CC-SSAZ-CWRUPN-20231019154549

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198016567
Report Date: 10/19/2023
Date Signed: 10/19/2023 03:46:01 PM

Document Has Been Signed on 10/19/2023 03:46 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	BURBANK MONTESSORI PRESCHOOL		FACILITY NUMBER:	198016567
ADMINISTRATOR:	MADLENA GORYAN		FACILITY TYPE:	850
ADDRESS:	332 E. VALENCIA AVENUE		TELEPHONE:	(818) 588-3206
CITY:	BURBANK	STATE: CA	ZIP CODE:	91502
CAPACITY:	38	CENSUS: 16	DATE:	10/19/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Melina Petrosyan, Director/Owner		TIME COMPLETED:	04:05 PM

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At 2:00pm, Licensing Program Analyst (LPA) Susann Sanchez arrived at the facility and was greeted by Josey Santana Delgado, who stated was on break and the director was on break. Brittney Delgado Tejeda, Assistant Director arrived at 2:20pm and Director/ Owner arrived at 2:35pm.

The following was observed and is being cited for a Type A:

At 2:05pm LPA went to the Classroom 3's and observed a staff napping on the on a to the right of the door. LPA said "hello," staff opened there eyes and but closed them again. LPA counted 12 children in the room.
At 2:06pm, LPA walked passed Classroom 3 into Classroom 2's and observed 4 napping child and staff back facing the opposite direction and was on the cell phone. LPA said "hello" and staff looked up. LPA counted 4 children.
At 2:15pm, LPA asked lead teacher for Josey Santana Delgado file for fingerprint clearance. Per records, Josey Santana Delgado fingerprints are not cleared and is in process. LPA called Monterey Park regional office to verify.

Consult was given for the following:

There needs to be visual supervision at all times.
Fingerprints need to be cleared before working at any license facility.

Due to time constraints, LPAs will return at a later date to complete annual inspection.

Based on the LPA’s observations, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22 Chapter 1 and Section CCR & H&S. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) -98-3350
LICENSING EVALUATOR NAME: Susann Sanchez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

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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Document Has Been Signed on 10/19/2023 03:46 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BURBANK MONTESSORI PRESCHOOL	FACILITY NUMBER: 198016567
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/19/2023

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 observation, the licensee did not comply with the section cited above. LPA observed 1 teacher sleeping and another teacher on their cell phone while children are sleeping. All other teachers were on break. This which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 10/20/2023
	Plan of Correction
1 2 3 4	Per Director/Owner Petrosyan will have a staff meeting and will write up staff to ensure there is always visible supervision. A copy will be provided to LPA by 10/20/23.

Request Denied

Type A

Section Cited

CCR

101170(e)

Criminal Record Clearance

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above. Per records, Josey Santana Delgado fingerprints are not cleared and is in process. This is poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 10/20/2023
	Plan of Correction
1 2 3 4	Josey Santana Delgado left to get fingerprinted just in case there was an error. Director plans to appeal citation. Per Director/Owner, she called multiple times to El Sedungo Regional Office and was told she was clear.

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: Valarie Cook	TELEPHONE: (323) -98-3350
LICENSING EVALUATOR NAME: Susann Sanchez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BURBANK MONTESSORI PRESCHOOL	FACILITY NUMBER: 198016567
	VISIT DATE: 10/19/2023

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A copy of this report shall also be posted where the parent/guardian of children enter and exit the facility. Both the notice of site visit and licensing report shall remain posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon their return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled child for the next 12 months. A signed Acknowledgement of Receipt (LIC9224) shall be in each child’s file, acknowledging receipt.

Exit interview was conducted with, Licensee copy of report was given. Appeal rights were issued and discussed.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) -98-3350
LICENSING EVALUATOR NAME: Susann Sanchez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

LIC809 (FAS) - (06/04)

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