198015235-6-3-2024-33-CC-SSAN-D5VUM8-20240603154155

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198015235
Report Date: 06/03/2024
Date Signed: 06/03/2024 03:42:03 PM

Document Has Been Signed on 06/03/2024 03:42 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	PENNSYLVANIA AVENUE MONTESSORI PRESCHOOL		FACILITY NUMBER:	198015235
ADMINISTRATOR/ DIRECTOR:	SONDRA WISE		FACILITY TYPE:	850
ADDRESS:	3966 PENNSYLVANIA AVENUE		TELEPHONE:	(818) 231-5605
CITY:	LA CRESCENTA	STATE: CA	ZIP CODE:	91214
CAPACITY: 56	TOTAL ENROLLED CHILDREN: 40	CENSUS: 20	DATE:	06/03/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:30 PM
MET WITH:	Marita Monfared		TIME VISIT/ INSPECTION COMPLETED:	04:00 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 06/03/24 , at 12:30 PM ,Licensing Program Analyst (LPA) Shushanik Safaryan conducted an unannounced annual /random inspection to the above facility. Upon arrival ,LPA met with Facility Representative Marita Monfared, who guided the LPA on a tour of the facility. This is a preschool age program which operates Monday through Friday from 06:30am to 6:00PM. There is an infant program on the premises with facility number 198015236. Program consists of 3 classrooms. Per Facility Representative there are 40 children enrolled. LPA observed all required forms/publications posted by the front entrance. The following classrooms were inspected: Classroom 1 for ages 3-4 (Pre K 1 ) : LPA observed 4 children with 1 staff members. Classroom 2 for ages 4-6 (Pre K 2) : LPA observed 6 children with 1 staff member. Classroom 3 for ages 2-3 (TK ) LPA observed 8 children with 2 staff members .Teacher child ratios were observed to be in accordance with Title 22 Regulations. Staff names were recorded. Licensed facility is within the conditions, limitations, and capacity specified on the license. All children were observed to be under visual supervision of a teacher at all times . LPA observed the facility to be clean , safe , sanitary and in a good repair .The classroom furniture and equipment were inspected for good repair, free of sharp, loose, or pointed parts. All classrooms were inspected to ensure that the floors have a surface that is safe and clean. All materials and surfaces accessible to children are toxic free. Telephone service, heating, lighting, and ventilation were evaluated . LPA observed water pitchers and disposal cups in each classroom. Per assistant director , children also use their own water cups. There are two bathrooms in the hallway of entrance. All toilets and washing facilities are in safe and sanitary operating conditions. Page 1 of 4

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: PENNSYLVANIA AVENUE MONTESSORI PRESCHOOL	FACILITY NUMBER: 198015235
	VISIT DATE: 06/03/2024

NARRATIVE

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First Aid supplies were observed to be in the kitchen cabinet. According to Assistant director, medication is only administered to a child when accompanied with a doctor's note and stored in the cabinet in the kitchen. 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 or entry area .The ill child will use the staff restroom during isolation which is disinfected immediately after use.

Napping equipment (cots) were observed to be stored in the corner of each classroom. Napping equipment and bedding were inspected for good condition, appropriate storage, and cleanliness. Storage for children's belongings was inspected. Children have their own cubby to store their belongings. Parents take linens home on Friday and returned on Monday.

LPA observed that there are functioning smoke and carbon detectors in the facility. LPA observed a fully charged and serviced fire extinguisher with the service date 11/09/23. Emergency disaster drill was last conducted on 04/02/24. Facility Representative states there are no weapons, firearms, or bodies of water on the premises.

Snack menus are posted one week in advance by the front entrance ,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. The facility provides AM, and PM snack. Per Facility Representative lunch is provided by outside vendor . There is a kitchen on site. The kitchen was observed to be clean, and the cleaning compounds/solutions were found to be stored away from the food.

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. Drinking water is readily available both indoors and outdoors, children bring their own water bottles too. The facility was observed to be free of flies, other insects, and rodents.

LPA observed two outdoor play areas for the preschool program. Outdoor playground equipment is in 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, slides, and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard.

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SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2024

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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: PENNSYLVANIA AVENUE MONTESSORI PRESCHOOL	FACILITY NUMBER: 198015235
	VISIT DATE: 06/03/2024

NARRATIVE

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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. Sign in sheets observed to be next to the entrance.

At 1:20 PM Children’s Records were reviewed for completeness . Inspection of required forms was made and documented on the LIC 857.

At 1:40 PM LPA reviewed staff records. During the inspection LPA reviewed 5 staff records . Staff #1 missing Health Screening , Staff #2 and Staff #5 were missing Immunization records .

Criminal Records Clearance for adults and verification of CPR/First Aid and health preventative practices documentation was reviewed. There is at least one person trained in CPR and Pediatric First Aid present during this inspection. The review of Staff records was documented on the LIC 859.

Staff #1 present had a expired Mandated Reporter Training certificate on file. LPA reminded Facility representative certificates renewed every two years .

AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018, any person who works in a childcare facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers.

Incidental Medical Services (IMS) policy was discussed. At this time , per Facility Representative IMS services not provided . For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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

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

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SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2024

LIC809 (FAS) - (06/04)

Page: 3 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: PENNSYLVANIA AVENUE MONTESSORI PRESCHOOL	FACILITY NUMBER: 198015235
	VISIT DATE: 06/03/2024

NARRATIVE

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Facility Representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Facility Representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

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 childcare 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 with the Written Directives outlined in PIN 21-21.1-CCP.

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.

Based on the LPA’s observations and records reviews, the following deficiencies listed on the attached LIC 809D (Deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health and safety.

An exit Interview was conducted, a copy of this report along with Notice of Site visit , Deficiency pages and Appeal Rights were explained and provided to the Facility Representative , Sondra Wise on 06/03/24.
The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative.
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SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/03/2024 03:42 PM - It Cannot Be Edited

Created By: Shushanik Safaryan On 06/03/2024 at 01:48 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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: PENNSYLVANIA AVENUE MONTESSORI PRESCHOOL	FACILITY NUMBER: 198015235
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/03/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101216(g)(2)

Personnel Requirements

(2) Each person specified in (g) above shall have a health-screening report signed by the person performing the screening. This report shall indicate the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observations ,interview and records review the licensee did not comply with the section cited above , during the file review staff #1 were misiing health screening report , staff #2 was missing proof of TB test , staff # 5 was missing proof of MMR , which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/24/2024
	Plan of Correction
1 2 3 4	Per Facility Represantative , employees will obtain missing form and immunization and submit the proof to the LPA by POC date .

Section Cited


	Deficient Practice Statement
1 2 3 4
	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.

SUPERVISOR'S NAME:

Claudia Guangorena

LICENSING EVALUATOR NAME:

Shushanik Safaryan

LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2024

LIC809 (FAS) - (06/04)

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