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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191203519
Report Date: 09/28/2023
Date Signed: 09/28/2023 02:43:13 PM

Document Has Been Signed on 09/28/2023 02:43 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:ST MARY'S ARMENIAN SCHOOLFACILITY NUMBER:
191203519
ADMINISTRATOR:AVANESSIAN, LORETTEFACILITY TYPE:
850
ADDRESS:1200 E CARLTON DRIVETELEPHONE:
(818) 240-7030
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY: 200TOTAL ENROLLED CHILDREN: 200CENSUS: 191DATE:
09/28/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Lorette Avanessian, DirectorTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced case management inspection today at 09/29/23 at 11:30 AM due to an incident that occurred between 08/22/23 to 09/01/23. LPA met with Lorette Avanessian, Director who guided analyst on a tour of the facility.

Alleged Incident took place between 08/22/23 to 09/01/23. Incident was reported via email on 09/08/23. Per director, as far as the incident did not have a specific time and date, she reported the incident to the department after her meeting with child#1's parent that was held on 09/06/23. Original LIC 624 Unusual Incident/Injury Report form was received by the Department within 7 days. The written incident report was received by email on Friday 09/08/23.

LPA conducted interviews with six staff. LPA watched camera video footage on director's computer for 08/23/23 at 10:17 AM and 08/23/23 at 14:06 PM. LPA obtained a copy of email conversation between school and child#1's parent and director notes regarding this alleged incident.

Per staff#1, She watched all child#1's classroom video footage from 08/22/23 to 09/01/22 and nothing was observed that the alleged incident occurred. Per staff#1, she completed her internal investigation and no disclosures were made regarding this alleged incident. Per staff#1, staff#2 was removed from child#1's classroom. Per staff#1, child#1 was withdrawn from school as of 09/01/23. Per staff#1, based on camera footage, child#1 and staff#2 were observed to have positive relationship.

Based on an interview that was conducted with staff#2, child#1 was a good child and mostly attached to staff#2. Per staff#2, alleged incident did not happen. Per staff#2, there were times that child#1 would show love by coming to staff#2, put hand on staff#2, fell into staff#2 (like ran into staff#2), but never hit child#1.

Based on interviews that were conducted with staff#3, staff#4, staff#5 and staff#6, they never observed any teacher to treat child#1 and any child in an inappropriate manner.
REPORT CONTINUES ON NEXT PAGE 1 OF 2
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2023
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 2
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: ST MARY'S ARMENIAN SCHOOL
FACILITY NUMBER: 191203519
VISIT DATE: 09/28/2023
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LPA issued the Confidential Names List (LIC 811) to the director during this inspection. The Confidential Names List documents the staff and children involved with the incidents documented in this report.

At this time, there is not a preponderance of evidence that shows that the facility was in violation with Title 22 Regulations when these incident occurred. Therefore, there are no deficiencies being cited.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Director, Lorette Avanessian at 2:30 PM..


END OF REPORT PAGE 2 OF 2
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023
LIC809 (FAS) - (06/04)
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