198013176-4-1-2025-58-CC-JKAN-DF7TYD-20250328150834

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198013176
Report Date: 03/28/2025
Date Signed: 04/01/2025 11:01:01 AM

Document Has Been Signed on 04/01/2025 11:01 AM - 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:	MARY ALICE O' CONNOR CCLC		FACILITY NUMBER:	198013176
ADMINISTRATOR/ DIRECTOR:	LILIAN DERGEVORKIAN		FACILITY TYPE:	850
ADDRESS:	401 N. BUENA VISTA STREET		TELEPHONE:	(818) 846-1063
CITY:	BURBANK	STATE: CA	ZIP CODE:	91506
CAPACITY: 68	TOTAL ENROLLED CHILDREN: 68	CENSUS: 56	DATE:	03/28/2025
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:20 AM
MET WITH:	Director / Lilian Dergevorkian		TIME VISIT/ INSPECTION COMPLETED:	03:30 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 3/28/25, at 9:20AM, Licensing Program Analyst (LPA) Joe Katrdzhyan conducted an Unannounced Required – 1 Year inspection to the above facility. Upon arrival, LPA met with Director / Lilian Dergevorkian and disclosed the purpose of the visit. Entrance Checklist – Child Care Centers was provided to the Director. Facility is currently licensed for a capacity of 68 children. Licensee serves 68 Preschool Children, ages 2 years of age until entry into first grade. The following staff/children were present during this inspection: Room 1 / Discovery: 3 Staff & 19 children, Room 2 / Pre-school: 2 Staff & 20 Children and Room 3 / Pre-K: 2 Staff & 17 Children. The facility was observed to be within the license capacity and limitations. Facility operation hours are Monday to Friday from 7:00 AM to 6:00 PM. A waiver has been approved for not meeting the indoor capacity of 68 children which the outdoor capacity limitation is 54 children. Licensee will stagger the outdoor activity time that no more than 54 children will be allowed during outdoor play time. LPA was taken on a guided tour of the facility of both indoors and outdoors. The furniture and equipment were inspected for age appropriateness and good repair. LPA observed surface of classrooms to be safe and clean, and child size tables and chairs available for children well maintained. LPA observed learning stations for dramatic play, math, and science with toys well maintained free of loose and sharp parts and a library area available for quiet play. Telephone service, heating, lighting and ventilation were evaluated. There were cubbies observed as storage for children's belongings. Mats/cots were inspected. Per Director, blankets are provided by the parents and are taken home weekly for washing. Linens are provided by the center and are washed weekly. Availability of drinking water was reviewed. LPA observed Brita water filter jugs available for children in each classroom and children's personal water bottles. Two out of the three preschool classrooms also have filtered drinking fountains inside the classrooms. Age appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, area safety and sanitation. Pg. 1 of 4

NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Joe Katrdzhyan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2025

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: MARY ALICE O' CONNOR CCLC	FACILITY NUMBER: 198013176
	VISIT DATE: 03/28/2025

NARRATIVE

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There is a First Aid kit located inside of each classroom. The First Aid kits were inventoried for necessary supplies. Carbon monoxide detectors and smoke detectors are present in the facility. Disaster drill log was available during today’s inspection, last disaster drill was conducted on March 26, 2025. Per Director, isolation area for sick children is in the Director's office. According to the Director, medication is only administered to a child when accompanied with a doctor's note and stored in a safe place inaccessible to children.

Snack menus were reviewed and observed posted. Snacks were reviewed for availability, quantity and appropriateness to children in care. Food preparation areas were toured for safety, cleanliness and proper equipment. Per Director, facility provides an AM snack and a PM snack to children in care. Parents provide lunches for their children.

Outdoor equipment was inspected for safety, cushioning material, good repair and age appropriateness. Required shade and fencing were inspected. LPA Katrdzhyan advised that the children need to be within the direct care and supervision, including visual supervision of the teacher(s) at all times. The children have access to personal water bottles during outside play. Play area was inspected for hazards and inaccessibility to bodies of water; no bodies of water or hazards observed.

Teacher-child ratios were observed and staff names recorded. Care and supervision was evaluated to determine if the basic needs of children are met and appropriate. Sign-in and out sheets and procedures were reviewed. Personal Rights of children were observed by LPA.

Staff and children’s records were reviewed. Inspection of required forms were made and documented on the LIC 857 for children and the LIC 859 for staff. Criminal Record Clearances were reviewed for adults. There is at least one staff member trained in CPR and Pediatric First Aid present during this inspection. The Director’s Pediatric First Aid and CPR expires on 7/15/23. Staff present did have proof of AB 1207 Mandated Reporter Training certificate on file.

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

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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Joe Katrdzhyan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2025

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: MARY ALICE O' CONNOR CCLC	FACILITY NUMBER: 198013176
	VISIT DATE: 03/28/2025

NARRATIVE

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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

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for
drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.
For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).
LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

MARY ALICE O' CONNOR CCLC completed lead testing on 3/8/23, however, the facility did not have a copy of the test results at the time. The results have been requested, and once received, they will be forwarded to Community Care Licensing.

The following were discussed with the Director:
Rooms that are off-limits need to be made inaccessible during operating hours. Smoking is prohibited.
To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Licensee (or facility representative) was reminded that all adults 18 and over in the facility, 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 licensed facility. 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.

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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Joe Katrdzhyan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2025

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: MARY ALICE O' CONNOR CCLC	FACILITY NUMBER: 198013176
	VISIT DATE: 03/28/2025

NARRATIVE

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Smoke and Carbon Monoxide detectors should be checked and batteries replaced as needed.

Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your location.

LPA advised the licensee to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

LPA advised of the requirement to report Unusual Incidents and/or injuries to the parent/guardian and to CCL within the time frame specified by the regulation.

The following concerns were observed during today's inspection:

During a tour of the kitchen, LPA observed that the entrance door was not locked. Upon entering, LPA noticed that chemicals were stored underneath the kitchen sink cabinet, within reach of children. Additionally, LPA observed knives and scissors in the kitchen drawer, also accessible to children. During a tour of the laundry room, LPA observed that the entrance door was not locked. Upon entering, LPA noticed that chemicals were stored underneath the cabinet, within reach of children. Additionally, LPA observed cleaning chemicals on the counter, also accessible to children. While the Director stated that the doors to the kitchen and laundry room are typically kept closed to prevent children from entering, it is essential that hazardous items be made inaccessible to children at all times.

The following deficiency listed on the attached deficiency page is being cited in accordance with California Code of Regulations Title 22. The Notice of Site Visit must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Lilian Dergevorkian, Director, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Joe Katrdzhyan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/01/2025 11:01 AM - It Cannot Be Edited

Created By: Joe Katrdzhyan On 03/28/2025 at 02:23 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MARY ALICE O' CONNOR CCLC	FACILITY NUMBER: 198013176
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/28/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101238(g)

Buildings and Grounds

(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA's observation, the licensee did not comply with the section cited above. During a tour of the kitchen, LPA observed that the entrance door was not locked. Upon entering, LPA noticed that chemicals were stored underneath the kitchen sink cabinet, within reach of children. Additionally, LPA observed knives and scissors in the kitchen drawer, also accessible to children. During a tour of the laundry room, LPA observed that the entrance door was not locked. Upon entering, LPA noticed that chemicals were stored underneath the cabinet, within reach of children. Additionally, LPA observed cleaning chemicals on the counter, also accessible to children. While the Director stated that the doors to the kitchen and laundry room are typically kept closed to prevent children from entering, it is essential that hazardous items be made inaccessible to children at all times. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/28/2025
	Plan of Correction
1 2 3 4	During today's visit, the Director removed all hazardous items (chemicals, knives & scissors) from the kitchen and laundry room and stored where inaccessible to children. Deficiency was cleared at the time of visit and no further action is needed.

Section Cited


	Deficient Practice Statement
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	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.

	Rita Ramos
NAME OF LICENSING PROGRAM MANAGER:

	Joe Katrdzhyan
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2025

LIC809 (FAS) - (06/04)

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