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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016567
Report Date: 11/29/2023
Date Signed: 11/29/2023 12:52:38 PM

Document Has Been Signed on 11/29/2023 12:52 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:BURBANK MONTESSORI PRESCHOOLFACILITY NUMBER:
198016567
ADMINISTRATOR:MADLENA GORYANFACILITY TYPE:
850
ADDRESS:332 E. VALENCIA AVENUETELEPHONE:
(818) 588-3206
CITY:BURBANKSTATE: CAZIP CODE:
91502
CAPACITY: 38TOTAL ENROLLED CHILDREN: 38CENSUS: 16DATE:
11/29/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Brittney Delgado, Assistant Director & Melina Petrosyan, Director/OwnerTIME COMPLETED:
01:10 PM
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Licensing Program Analysts (LPA) Susann Sanchez conducted an unannounced annual contiuation inspection from 10/19/23 at the above facility. LPA met with Assistant Director Brittney Delgado and informed her of the purpose of the visit. Assistant Director provided LPA a tour of the facility at 11:00am. The facility operates Monday through Friday, from 8:00 AM to 5:00 PM. Director/ Owner Melina Petrosyan arrived at 11:50am.

Currently there are 4 staff present along with the directors. Facility is operating within capacity limitations. The facility consists of 3 classrooms (2 year old class, 3 year old class, and 4-5 year old class ), Director's office (located in the back of the 3 year old class)) , and play yard in the back. Director office is used as the isolation area for sick children. LPA review of the sign in/out sheet was conducted to verify the current census of children.

LPA observed all preschool classroom to be clean and in good repair. The floors were clean and lighting was in operable condition. There were age appropriate toys and equipment. LPA observed water readily available via water pitchers provided by facility. LPA observed cups available in each classroom. LPA observed cubbies/storage area for children to store their personal belongings. Smoke detector and carbon monoxide detector were observed to be in operable condition. LPA observed 3 Fire extinguishers at the facility and was serviced on 05/05/2023.

First Aid kit was observed and inventoried. Appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, paper towels, and general sanitation. Disinfectants and cleaning solutions were observed to inaccessible to children in care. Per Administrator there are no poisons stored at the facility also there are no weapons. Napping equipment and bedding were inspected and found to be clean and in operable condition. Per Director, bedding is sent home weekly to be washed.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2023
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: 11/29/2023
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LPA toured the outdoor play area. LPA observed age-appropriate toys and material for children, free of loose, sharp, and/or pointed parts. LPA observed required cushioning under climbing structure to absorb a fall. Shade was observed in the outdoor area. Per Director, children also has use there water bottle. LPA observed no large bodies of water on the premises.

The facility provides lunch as needed, and snacks. Children bring lunch from home. Food storage area to be clean and free of litter, rubbish, rodents, and/or any other vermin. LPA observed refrigerators to be clean and in operable condition. LPA observed required posted documentation which included, Facility License, LIC610- Emergency Disaster Plan, Publication (PUB) 393- Notification of Parent Rights, PUB 269- Child Passenger Restraint System, LIC 613A- Notification of Personal Rights. All documents were observed to be posted in the main lobby area. LPA observed Sign in/out sheets, LIC 9148 Earthquake Preparedness, Daily Activity Schedule, and Verification of Disaster and Fire Drills (last conducted on 10/19/23). Proof of lead testing was posted at the entrance.

Children’s records were reviewed for LIC 613A- Personal Rights, Admission Agreement, Immunization Records, LIC 700- Identification and Emergency Information, LIC 701- Physician’s Report, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights.

Staff records were reviewed for approved, LIC 508-Criminal Record Statement, LIC 503- Health Screening Report, LIC 9052- Employee Rights, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, and LIC 9108- Statement of Child Abuse, and current Mandated Reporter.

Licensee 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.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023
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: 11/29/2023
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing 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: https://www.ada.gov/resources/child-care-centers/.

Also during inspection, POCs were cleared from 10/19/23 inspection. Director/Owner also updated roster. LPA printed "Letter of Appeal Acknowledgment" dated 11/03/23. Per Director/Owner had not received letter.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director/Owner M. Petrosyan.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023
LIC809 (FAS) - (06/04)
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