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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198020038
Report Date: 10/06/2021
Date Signed: 10/06/2021 12:33:25 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/01/2021 and conducted by Evaluator Thelma Razo
PUBLIC
COMPLAINT CONTROL NUMBER: 33-CC-20211001105323
FACILITY NAME:AMERICAN MONTESSORI PRESCHOOL & ELEMENTARY INC.FACILITY NUMBER:
198020038
ADMINISTRATOR:NOELINE SHANMUGANFACILITY TYPE:
850
ADDRESS:4817 EAGLE ROCK BLVDTELEPHONE:
(323) 257-3709
CITY:LOS ANGELESSTATE: CAZIP CODE:
90041
CAPACITY:20CENSUS: 8DATE:
10/06/2021
UNANNOUNCEDTIME BEGAN:
09:01 AM
MET WITH:Vlasta Blaha, AssistantTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Representative not provide an agreement.

INVESTIGATION FINDINGS:
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On 10/6/2021 at 9:01AM, Licensing Program Analyst (LPA) Thelma Razo arrived at the facility and was greeted by staff Helen Mangahis. Ms. Vlasta Blaha arrived at 9:45AM. LPA stated the purpose of the visit is to ascertain the validity of the complaint.

LPA interviewed Staff #1 (S1) and Staff #2 (S2). Interviews have revealed that Director Noeline Shanmugan, staff Helen Mangahis and staff Vlasha Blaha are responsible for enrolling the children. Per interviews, parents are given the tour, application packet and parent handbook. A copy of application packet was provided to LPA which include the Application for Enrollment, Preschool Admission Agreement, licensing forms, Acknowledgment (that school policies and Admission Agreement was read), and email request form. Per S1, P1 was not provided with a copy of the admission agreement (dated 7/21/2021) because P1 has filled and signed this document. Per S2, starting 9/1/2021, all parents are submitting their signed admission agreement via email. LPA reviewed Child #1's (C1) record and it revealed that P1 was provided with incorrect admission agreement, Infant & Toddler Application for Enrollment, instead of. the Preschool enrollment packet. There's no acknowledgment on C1's file that P1 read the school policies and Admission Agreement.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Thelma Razo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 33-CC-20211001105323
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: AMERICAN MONTESSORI PRESCHOOL & ELEMENTARY INC.
FACILITY NUMBER: 198020038
VISIT DATE: 10/06/2021
NARRATIVE
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Based on LPA’s observation, interviews, and record review, the preponderance of the evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 is being cited on the attached LIC9099-D.

A technical violation per Section 101219(a) was issued for providing incorrect infant/toddler admission agreement instead of preschool admission agreement. Refer to LIC 9102TV.

The notice of site visit was posted where the parent/guardian of children enter and exit the facility. This notice shall remain posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.

Exit interview conducted with Assistant Vlasta Blaha, during which appeal rights were explained.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Thelma Razo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 33-CC-20211001105323
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: AMERICAN MONTESSORI PRESCHOOL & ELEMENTARY INC.
FACILITY NUMBER: 198020038
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/06/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/13/2021
Section Cited
CCR
101219(e)
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Admission Agreements. The licensee shall keep the original copy of the admission agreement and give a photocopy to the child's authorized representative. This requirement was not met as evidenced by:
Per Staff #1's own admission, Parent #1 was not provided with a copy of admission
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Director is to submit to LPA by due date a plan on how to address the deficiency.
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agreement. This poses a potential health and safety risk to the children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Thelma Razo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 4