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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016567
Report Date: 06/18/2024
Date Signed: 06/19/2024 07:36:27 AM


Document Has Been Signed on 06/19/2024 07:36 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:BURBANK MONTESSORI PRESCHOOLFACILITY NUMBER:
198016567
ADMINISTRATOR:MADLENA GORYANFACILITY TYPE:
850
ADDRESS:332 E. VALENCIA AVENUETELEPHONE:
(818) 588-3206
CITY:BURBANKSTATE: CAZIP CODE:
91502
CAPACITY:38CENSUS: 10DATE:
06/18/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Staff / Karine Karapetyan
Licensee Representative / Melina Petrosyan		TIME COMPLETED:
04:00 PM
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On 6/18/2024, at 8AM, Licensing Program Analysts (LPAs) Joe Katrdzhyan and Roberto Avila Luque conducted an Annual / Random inspection to the above facility. Upon arrival, LPAs met with Licensee Representative / Melina Petrosyan 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 38 children. This is a preschool program which consists of three (3) classrooms; 2 year old class, 3 year old class and 4 - 5 year old class. LPAs were guided on a tour of the facility with the assistance of the Licensee Representative. There were 10 children with 2 staff observed. The facility was observed to be within the license capacity and limitations. Facility operation hours are Monday through Friday from 8AM to 5PM.

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 Licensee Representative, Linens and blankets are provided by the parents and are taken home weekly for washing. Availability of drinking water was reviewed. LPA observed pitchers of water in each classroom. Facility uses a water filtration system for the children in care. Age appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, area safety and sanitation.

There is a First Aid kit kept in each classroom. The First Aid kit was 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 in May of 2024. Per Licensee Representative, isolation area for sick children is in the Director's office. According to the Licensee Representative, medication is only administered to a child when accompanied with a doctor's note and stored in a safe place inaccessible
SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Joe KatrdzhyanTELEPHONE: (424) 301-3049
LICENSING EVALUATOR SIGNATURE:
DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/18/2024
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: BURBANK MONTESSORI PRESCHOOL
FACILITY NUMBER: 198016567
VISIT DATE: 06/18/2024
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to children.

Snack/lunch menus were reviewed and observed posted. Food and snacks were reviewed for availability, quantity and appropriateness to children in care. Food preparation areas were toured for safety, cleanliness and proper equipment. Per Licensee Representative, facility provides AM/PM snacks and lunch in the event a child does not bring lunch to the facility..

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 drinking water during outside play (from pitchers). Play area was inspected for hazards and inaccessibility to bodies of water; no bodies of water were 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 LPAs.

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 02/11/2025. Staff present did have proof of AB 1207 Mandated Reporter Training certificate on file.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.
SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Joe KatrdzhyanTELEPHONE: (424) 301-3049
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: BURBANK MONTESSORI PRESCHOOL
FACILITY NUMBER: 198016567
VISIT DATE: 06/18/2024
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CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES:
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.

Burbank Montessori Preschool completed lead testing on 7/15/2021 and the test results were in compliance.


The following were discussed with the Licensee Representative:
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 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.
SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Joe KatrdzhyanTELEPHONE: (424) 301-3049
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: 06/18/2024
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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 concerns below were observed during today's visit;

  • At 9:09AM, LPAs observed the fence in the back was in disrepair and disattached from the top right hinge causing it to tilt. The fence was being held up by the gate latch making it unsafe for the well being of children, employees and visitors. (Pictures taken)


  • At 9:05AM, LPAs found bleach in the play yard left unlocked and accessible to children. At 9:06AM, LPAs observed an unsecured shed near the play yard with gardening tools (such as shovel & 2 rakes) and poisons (such as Home Defense Spray) left unlocked and accessible to children. At 9:08AM, LPAs found a pair of scissors on the playground left accessible to children. At 9:12AM, LPAs found potting mix and insect poison "Black Flag Lawn Insect Killer" left unlocked and accessible to children.
SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Joe KatrdzhyanTELEPHONE: (424) 301-3049
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/19/2024 07:36 AM - 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: 06/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101238(a)
Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 9:09AM, LPAs observed the fence in the back (near the play area) was in disrepair and disattached from the top right hinge causing it to tilt. The fence was being held up by the gate latch making it unsafe for the well being of children, employees and visitors. (Pictures taken) This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/19/2024
Plan of Correction
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Licensee will repair the broken fence in the back (near the play area) and submit proof of correction to CCL by the POC due date.
Type A
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
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At 9:05AM, LPAs found bleach in the play yard left unlocked and accessible to children. At 9:06AM, LPAs observed an unsecured shed near the play yard with gardening tools (such as shovel & 2 rakes) and poisons (such as Home Defense Spray) left unlocked and accessible to children. At 9:08AM, LPAs found a pair of scissors on the playgound left accessible to children. At 9:12AM, LPAs found potting mix and insect poison "Black Flag Lawn Insect Killer" left unlocked and accessible to children. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/18/2024
Plan of Correction
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During today's visit, the Licensee secured all hazardous items making them inaccessible to children. Deficiency was cleared at the time of visit. No further action is needed.
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: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Joe KatrdzhyanTELEPHONE: (424) 301-3049
LICENSING EVALUATOR SIGNATURE:
DATE: 06/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/18/2024
LIC809 (FAS) - (06/04)
Page: 5 of 6


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: 06/18/2024
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The following deficiencies were observed to be in violation of California code of Regulations, Title 22, Division 6 (refer to 809D).

Upon receipt of this report, the Licensee shall post the Notice of Site Visit and any Licensing report
documenting a type “A” deficiency. 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. 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). The Acknowledgement of Receipt (LIC 9224 form must be
maintained in each child ’s file immediately upon receipt from parent. Licensee was provided with a copy of
the Acknowledgement of Receipt of Licensing Reports (LIC 9224) Form during this visit.

A notice of site visit was given and must remain posted for 30 days.

Exit interview was conducted and report was reviewed with the Licensee Representative and Appeals Rights provided.
SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Joe KatrdzhyanTELEPHONE: (424) 301-3049
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
LIC809 (FAS) - (06/04)
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