Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019499
Report Date: 08/05/2019
Date Signed: 08/05/2019 04:28:46 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:PLAY PRESCHOOLFACILITY NUMBER:
198019499
ADMINISTRATOR:GABRIEL ROSSFACILITY TYPE:
830
ADDRESS:2828 GLENDALE BLVDTELEPHONE:
(323) 664-8494
CITY:LOS ANGELESSTATE: CAZIP CODE:
90039
CAPACITY:50CENSUS: 24DATE:
08/05/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Annie GekozyanTIME 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
Licensing Program Analyst (LPA) Janeth Chavez and Licensing Program Manager (LPM) Claudia Guangorena conducted an unannounced Case Management inspection to the above facility. The staff present during this inspection are Annie Gekozyan, Gabriel Ross, and Karna C. Blugrind. During this inspection the following deficiencies were observed and are being cited:

During the Case Management inspection and tour of the infant center there are two staff members present that are not associated to the infant center. Licensing staff observed Angeles Reynoso present and actively caring for infants. As per Alemania Garcia, Assistant Director stated Angeles Reynoso has been actively caring for infants as of 07/26/2019. Licensing also observed Ana Razo, a student teacher, actively caring for infants and has not been associated to the infant center. As per Ana Razo she has been employed in the facility as of last week. Licensing staff checked the Licensing Information System (LIS) to verify if Angeles Reynoso and Ana Razo were associated to the facility but in fact the staff named are not associated. This is an immediate health and safety risk to the children in care. A civil penalty of $500 dollars will be issued for each staff member not associated to the facility prior to working. Also, it was stated by Annie Gekozyan that in fact Eliza Coburn had been actively working in the facility for about a month with the staff and present around the infant children. Licensing staff verified LIS and this staff was not associated to the facility prior to working. As per Annie Gekozyan, Eliza Coburn is no longer employed in the facility. She was the interim director temporarily on site.

The LIC 9040 Child Care Roster was incomplete for the infant center and was missing a couple of names of some infants enrolled. This is a potential health and safety risk to the children in care. Licensing staff provided a blank LIC 9040 to Annie Gekozyan. The following staff will be attending Step II Orientation for Child Care Centers: Annie Gekozyan and Karna C. Blugrind.

The following is being cited in accordance with California Code of Regulations Title 22. See 809-D.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) -98-3417
LICENSING EVALUATOR NAME: Janeth ChavezTELEPHONE: (323) 981-3376
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: PLAY PRESCHOOL
FACILITY NUMBER: 198019499
VISIT DATE: 08/05/2019
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
26
27
28
29
30
31
32
*A Civil Penalty has been assessed during this inspection. Payment is due when billed and the check(s) or money orders shall be made payable to the “California Department of Social Services”. The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.

Whenever a type A is cited: “Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.”



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. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Licensee, Annie Gekozyan, Appeal Rights discussed and explained.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) -98-3417
LICENSING EVALUATOR NAME: Janeth ChavezTELEPHONE: (323) 981-3376
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: PLAY PRESCHOOL
FACILITY NUMBER: 198019499
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
08/09/2019
Section Cited

1
2
3
4
5
6
7
Criminal Record Clearances

Request a transfer of a criminal record clearance as specified in Section 101170(f) or
8
9
10
11
12
13
14
This requirement is not met as evidenced by licensing staff observing two staff actively caring for infants and are not associated to the facility prior to working. Licensing staff verified LIS to see if Ana Razo, Angeles Reynoso and Eliza Coburn are not associated to the facility. This is an immediate health and safety risk to the children in care.
8
9
10
11
12
13
14
risk to the children in care.

1
2
3
4
5
6
7

1
2
3
4
5
6
7
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 GuangorenaTELEPHONE: (323) -98-3417
LICENSING EVALUATOR NAME: Janeth ChavezTELEPHONE: (323) 981-3376
LICENSING EVALUATOR SIGNATURE:
DATE: 08/05/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/05/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: PLAY PRESCHOOL
FACILITY NUMBER: 198019499
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)

1
2
3
4
5
6
7

1
2
3
4
5
6
7

1
2
3
4
5
6
7

1
2
3
4
5
6
7
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 GuangorenaTELEPHONE: (323) -98-3417
LICENSING EVALUATOR NAME: Janeth ChavezTELEPHONE: (323) 981-3376
LICENSING EVALUATOR SIGNATURE:
DATE: 08/05/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/05/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4