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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191228958
Report Date: 09/14/2022
Date Signed: 09/14/2022 03:14:14 PM

Document Has Been Signed on 09/14/2022 03:14 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:AGBU MANOOGIAN-DEMIRDJIAN SCHOOLFACILITY NUMBER:
191228958
ADMINISTRATOR:TAGOUSH KHODABAKSHIANFACILITY TYPE:
850
ADDRESS:6844 OAKDALE AVENUETELEPHONE:
(818) 883-2428
CITY:CANOGA PARKSTATE: CAZIP CODE:
91306
CAPACITY: 219TOTAL ENROLLED CHILDREN: 219CENSUS: 183DATE:
09/14/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:18 AM
MET WITH:TAGOUSH KHODABAKSHIANTIME COMPLETED:
03:30 PM
NARRATIVE
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On 09/14/2022 Licensing Program Analyst (LPA) Laticia Thompson arrived at AGBU MANOOGIAN-DEMIRDJIAN SCHOOL to conduct an unannounced case management visit regarding Action Lead Exceedance (ALE). LPA Thompson was greeted by Vanessa Aguilera (Director of Health Safety and Security and TAGOUSH KHODABAKSHIAN (Director of Preschool). LPA Thompson informed director about the purpose of the visit. LPA was guided on a tour of the classrooms with director for census purposes. LPA observed 10 classrooms with a total of 183 children and 22 staff members.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018 requires all licensed Child Care Centers (CCC’s) constructed before January 1,2010 to test their drinking water for lead contamination between January 1, 2020 and January 1, 2023, and then every five years after the date of the first test.

Community Care Licensing was notified that lead water testing conducted at the facility on 8/12/2022 exceeded allowable limit for lead. Samples testing over 5.5 ppb/ug L and above is considered an exceedance. The Purpose of today’s visit is to follow up lead testing results of Action Level Exceedances (ALE) and conduct an inspection.

During today’s visit LPA Thompson was guided on a tour with Ms Aguilera of for the purpose of identifying outlets and faucets that exceed the allowable levels. LPA Thompson observed water facet/outlets M,E,B,D,G,DD,O,F,SS identified on facility sketch. There was an error on facility sketch SS should read S. Ms. Aguilar will provide pictures and an updated facility sketch to the department within 2 business days. All outlets identified on the sketch that exceed the levels were covered, taped off and signs stating out of service were posted. The facility has ceased usage of outlets or faucets for drinking or food preparation. As an alternative the children and staff bring drinking water bottles daily. The facility provides bottled water daily during lunch time. LPA observed packages of bottled water in each classroom sink areas. Ms Aguilera stated the kitchen area is only used for storage of food that has already been prepared in a separated area

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2022
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: AGBU MANOOGIAN-DEMIRDJIAN SCHOOL
FACILITY NUMBER: 191228958
VISIT DATE: 09/14/2022
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This facility is being cited (1) deficiency during today’s visit 9/14/2022. This is a type B violation which poses a potential Health, Safety or Personal Rights risk to persons in care.

LPA discussed Proof of Correction (POC) with Director Notification of letter will be sent out to parents with notifying there has been a cease of water outlets and remediation for planned for water outlets or alternative. Director will send LPA a copy of the letter via email by 9/19/2022. Director will follow up with California Rural Water Association for additional guidance.

LPA provided Facility with PIN 21-21 CCP and Lead Poisoning in Child Care Centers Frequently Asked Questions , 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. An exit interview was conducted with Vanessa Aguiler, (Director of Health, Safety and Security), including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/14/2022 03:14 PM - It Cannot Be Edited


Created By: Laticia S Thompson On 09/14/2022 at 02:44 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: AGBU MANOOGIAN-DEMIRDJIAN SCHOOL
FACILITY NUMBER: 191228958

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/14/2022
Section Cited
CCR
101700.3(b)(1)

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101700.3(b)(1) California Lead Action Levet at child Care Center: A result of values of 5.5ppb or greater sahll be demed an Acion Level Exceedence. This requirement was not met as evidence by
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Facility agrees to temporaily shut off outlets change fixtures or change filter or remove fixtures by 9/28/2022. Facility representaive will notify department with a declaration, pictures and receipts.
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Lead water testing samples taken on 8/12/2022 revealed that levels of lead were beyond allowable amount deemed by the State of California for faucets/outlets labled on facility sketch M,E,B,D,G,DD,O,F,SS. This poses a potential health and safety risk to 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.
SUPERVISOR'S NAME:Lisa Rios
LICENSING EVALUATOR NAME:Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2022


LIC809 (FAS) - (06/04)
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