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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198019175
Report Date: 11/01/2019
Date Signed: 11/01/2019 01:44:33 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/21/2019 and conducted by Evaluator Anomeh Eivazian
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20191021120647
FACILITY NAME:BRIGHT FUTURE MONTESSORI INC.FACILITY NUMBER:
198019175
ADMINISTRATOR:SYUZANNA JEREJYANFACILITY TYPE:
850
ADDRESS:1911 WALTONIA DR.TELEPHONE:
(818) 309-4422
CITY:MONTROSESTATE: CAZIP CODE:
91020
CAPACITY:63CENSUS: 43DATE:
11/01/2019
UNANNOUNCEDTIME BEGAN:
10:53 AM
MET WITH:Varduhi Hareyan, Licensee and Syuzanna Jerejyan, DirectorTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Child sustained multiple injuries while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Anomeh Eivazian, conducted an inspection to the above facility for the purpose of delivering complaint investigation finding. LPA met with Varduhi Hareyan, Licensee and Syuzanna Jerejyan, Director who assisted LPA with tour of the facility. During this inspection there were 37 preschoolers and 6 toddlers present in the facility.

During this investigation, LPA Eivazian conducted interviews with Complainant, Licensee, Director, and child#1. A copy of facility sing in/out sheet for October 2019 was obtained.
Based on interviews conducted with director and staff#1, child#2 sustained a red mark on forehead on 10/08/19 while he was in care. Per staff#1, child#2 stated to staff#1 that while playing under the table, bumped head under the table and got red mark on forehead. However, staff#1 did not see how the incident occurred.

REPORT CONTINUES ON THE NEXT PAGE 1 OF 2
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 33-CC-20191021120647
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: BRIGHT FUTURE MONTESSORI INC.
FACILITY NUMBER: 198019175
VISIT DATE: 11/01/2019
NARRATIVE
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Also, per director and staff#1, on 10/17/19 while child#2 was playing outside, fell on grass area and got bruises under eye. However, staff#1 did not see how the incident occurred. Both incidents were not reported to the Licensing Department in a timely manner. Both incidents were reporter to CCL by phone on 10/30/19.

Based on LPA's file review, facility was observed to be incompliance with Teacher-Child Ratio on 10/08/19 and 10/17/19.

Based on LPA observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been meet, therefore the above allegation is found to be SUBSTANTIATED at this time. California Code of Regulations, 101229(a)(1), Responsibility for Providing Care and Supervision and 101212(d)(1)(B), Reporting Requirements are being cited on the attached LIC9099D.

Upon receipt of this report documenting a substantiated complaint allegation and a Type A deficiency, the Licensee shall do the following:
1. Post the Notice of Site visit and any licensing report documenting a Type “A” deficiency.
2. The report and the Notice of Site visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty.
3. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year).
4. The Acknowledgement form (LIC 9224) must be maintained in each child’s file immediately upon receipt from parent. A copy of the parent Acknowledgement of Receipt of Licensing Reports Form was provided during this inspection.

Exit interview was conducted with Syuzanna Jerejyan, Director, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role. A copy of this report and all other Licensing reports must be made available to the public for 3 years.
REPORT END 2 OF 2
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 33-CC-20191021120647
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: BRIGHT FUTURE MONTESSORI INC.
FACILITY NUMBER: 198019175
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/04/2019
Section Cited
CCR
101212(d)(1)(B)
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Reporting Requirements
Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours.
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On 10/30/19 director reported both incidents via phone and during this inspection LPA obtained written reports.

Plan of corrections were cleared during this inspection.
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This requirement has not been met as evidence by LPA's file review. Licensee did not report Child #1 fell down on 10/08/19 and got red mark on forehead and on 10/17/19 fell down and got bluish bump under eye.
This is a potential risk to health and safety of children in care.
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A written declaration was submitted by director to report Unusual Incident report in a timely manner.
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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) 854-8930
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2019
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 33-CC-20191021120647
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: BRIGHT FUTURE MONTESSORI INC.
FACILITY NUMBER: 198019175
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/04/2019
Section Cited
CCR
101229(a)(1)
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Responsibility for Providing Care and Supervision
The licensee shall provide care and supervision as necessary to meet the children's needs.
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
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Per director, she will make sure to have a floater teacher during outdoor playtime. Teachers will visually observe and supervise children during outdoor playtime. Teachers will change their stations every 15 minutes. During next staff meeting director will conduct refreshing training about visual observation, care and supervision
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101230(c)(1). Supervision shall include visual observation.
This requirement has not been met as evidenced by complaint investigation that no teacher observed how child#1 had incidents on 10/08/19 and 10/17/19.
This poses an immediate risk to health and safety of children in care.
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and will show Care and Supervision video from CCL website to staff and will submit a copy of teachers attendance sheet to LPA.

A written declaration was submitted during this inspection.
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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) 854-8930
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2019
LIC9099 (FAS) - (06/04)
Page: 3 of 4