191890481-7-7-2026-58-CC-DDOG-DVRR7Y-20260707124707

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191890481
Report Date: 07/07/2026
Date Signed: 07/07/2026 12:47:20 PM

Document Has Been Signed on 07/07/2026 12:47 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:	PACOIMA EARLY EDUCATION CENTER		FACILITY NUMBER:	191890481
ADMINISTRATOR/ DIRECTOR:	JENNIFER MOVSESSIAN		FACILITY TYPE:	850
ADDRESS:	11059 HERRICK ST.		TELEPHONE:	(818) 896-3722
CITY:	PACOIMA	STATE: CA	ZIP CODE:	91331
CAPACITY: 115	TOTAL ENROLLED CHILDREN: 96	CENSUS: 67	DATE:	07/07/2026
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:09 AM
MET WITH:	Jennifer Movessian, Principal		TIME VISIT/ INSPECTION COMPLETED:	01:00 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	On 07/07/2026, Licensing Program Analyst (LPA's) Dawn Dowling and John Mooberry, arrived at the facility to conduct an unannounced Case Management- Incident investigation. Upon arrival, LPA's were greeted by Principal, Jennifer Movsessian, to whom the purpose of the inspection was announced and who then guided LPA's on a tour to take census.` The Toddler Room #1 classroom there were 8 children with 3 staff; in Room 2B there were 15 children with 3 staff, in Room 3A there were 14 children with 3 staff, in Room 3B there were 17 children with 3 staff, outside classes 3B and 2A were combine and there were 30 children with 6 staff. During today's inspection, interviews were conducted with two staff, parent, observation of outside area where child fell and injured himself, took photograph of shelf that child fell on. LPA's obtained the following documentation: Notice of First Aid, Cautions Regarding Head Injury report. This Case Management- Incident is pertaining to the Unusual Incident Report (UIR) that was emailed in on 05/28/2026, due to an incident that occurred on 05/27/2026, where child lost balance, hit mouth on shelf, lip bled and was swollen. According to Staff interviewed, child was outside and lost his balance, child fell and hit his mouth on the shelf that was nearby. Staff did not observe any other children around that could have pushed the child. Staff indicated that child lost his balance, child was just standing there and then fell, nothing was on or around area that could have caused child to fall. Staff provided child with first aid. The injured area was washed and ice pack was provided for child. Staff telephoned mom and informed mom of incident, mom picked up child at regular time and was given Notice of First Aid, Cautions Regarding Head Injury Reports.

NAME OF LICENSING PROGRAM MANAGER: Betty Bell
NAME OF LICENSING PROGRAM ANALYST: Dawn Dowling
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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: PACOIMA EARLY EDUCATION CENTER	FACILITY NUMBER: 191890481
	VISIT DATE: 07/07/2026

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Parent interviewed indicated child sustained swollen mouth, couldn't eat or talk at first. Due to parent concern of child's mouth, child was taken to Dentist the day of the incident , Dentist assessed the child, parent was instructed to give ibuprofen for pain and applied ice pack to area for a few days. Parent indicated school informed parent of incident and was given documentation regarding the incident. Parent feels the incident was an accident, child still navigating balance and has issues with balancing.
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Based on interviews conducted and documentation obtained, this was an accident. The classroom was in ratio at the time of the incident. Staff observed the incident and the child was immediately tended to after the incident. Parent sought consultation with child's Dentist due to swelling, which went down after a week. It has been determined that there were no deficiencies in compliance found, no citations are being issued.

A Notice of Site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Principal, Jennifer Movsessian..

NAME OF LICENSING PROGRAM MANAGER: Betty Bell
NAME OF LICENSING PROGRAM ANALYST: Dawn Dowling
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2026

LIC809 (FAS) - (06/04)

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