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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198012408
Report Date: 06/27/2025
Date Signed: 06/27/2025 01:37:37 PM

Document Has Been Signed on 06/27/2025 01:37 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:PACIFIC AVENUE EDUCATION CENTERFACILITY NUMBER:
198012408
ADMINISTRATOR/
DIRECTOR:		YURITZY VAZQUEZFACILITY TYPE:
850
ADDRESS:440 W. LOMITA AVE.TELEPHONE:
(818) 547-0103
CITY:GLENDALESTATE: CAZIP CODE:
91204
CAPACITY: 89TOTAL ENROLLED CHILDREN: 56CENSUS: 51DATE:
06/27/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Carol Gregory, Program SupervisorTIME VISIT/
INSPECTION COMPLETED:
01:50 PM
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Licensing Program Analysts (LPA) Anomeh Eivazian and Shushanik Safaryan conducted an unannounced case management inspection on 06/27/25 due to an incident that occurred on Tuesday, 06/24/25. LPAs arrived at the facility at 9:00 AM and met with Carol Gregory, Program Supervisor who guided analyst on a tour of the facility. This is a state preschool program which consists of 4 classrooms; Room P1(1107), Room 32, Room 34, and Room 35. This facility is located on Pacific Avenue Education Center property that belong to Glendale Unified School District. Facility operation hours are from Monday to Friday from 6:30 AM to 6:00 PM. There are school age program and Elementary program on this site. All the programs are under Glendale Unified School District.

Alleged Incident took place on Tuesday 06/24/25. Incident was reported via email on 06/25/25. The written Report was received via email on 06/25/25. The facility reported the incident within the required 24 hour time frame.

LPA Eivazian conducted interviews with four staff. LPA obtained copies of documents from school internal investigation. Site Supervisor will provide LPA with a copy of video footage for 06/24/25 from 4:20 PM to 4:30 PM.

Based on interviews that were conducted with four staff, on 06/24/25 at the time of the incident between 4:20 PM to 4:30 PM, there were 16 children present on the playground with four staff.

Based on four staff interviews, they did not observe how and when child#1 left the preschool playground and went to the school front area and came back to the school lobby between two clear doors where child #1 was found by staff#2. Based on four staff interviews, and staff#1 observation from school video footage, child#1 did not observe outside the school premises.


REPORT CONTINUES ON NEXT PAGE 1 OF 3
NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Anomeh Eivazian
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/27/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PACIFIC AVENUE EDUCATION CENTER
FACILITY NUMBER: 198012408
VISIT DATE: 06/27/2025
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Based on staff#1 interview, she observed facility video footage for 06/24/25 from 4:20:20 PM to 4:29:07 PM. Per staff#1, she observed in video footage as follows:
At 4:24:07 PM, child#1 ran out from preschool playground with her backpack and water bottler in hand, by using the walk way which leads to the front lobby. (Camera 16)
At 4:25:03 PM, child#1 was observed at the school front yard, outside the office area with child#2 who was picked up by parent (Camera 2)
At 4:28:29 PM, child#1 was observed in the lobby area of the school between two clear doors. (Camera 12) were staff#5, asked child#1 where is your parent?
At 4:29:07, staff#2 was observed at the lobby area and observed child#1 unsupervised and alone in the lobby area and took child#1 back to the preschool outdoor playarea.

Based on staff#1 interview and camera footage that was watched by staff#1, child#1 was unsupervised and alone approximately from 4:24:07 PM to 4:29:07, approximately 5 minutes.

During this inspection LPAs Eivazian and Safaryan along with Program Supervisor, Carol Gregory counted with foot steps how far the child#1 went from outdoor playground to where child#1 was found. It was counted 57 foot steps from beginning of outdoor walk away to the lobby blue entrance door, 13 foot steps from blue outdoor lobby entrance door to first lobby clear door, 5 foot steps between two lobby clear doors, 38 foot steps from entrance door to side gate which leads to the outdoor playarea, 38 foot steps from outdoor playarea gate to the entrance door. Child#1 approximately went far unsupervised 151 footsteps.

Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been meet, therefore the above incident that occurred on 06/24/25 and child#1 was wondered away from facility is found to be Substantiated at this time. California Code of Regulations, 101229(a) (1)-- Responsibility for Providing Care and Supervision--(a)The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation and Personal Rights-- 101223(a)(2)--Per The licensee shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs are being cited on the attached LIC9099D.
REPORT CONTINUES ON NEXT PAGE 2 OF 3
NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Anomeh Eivazian
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2025
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PACIFIC AVENUE EDUCATION CENTER
FACILITY NUMBER: 198012408
VISIT DATE: 06/27/2025
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LPA Anomeh Eivazian informed Program Supervisor, Carol Gregory that this report dated 06/27/25 documents 2 of Type A citations. Type A citations which shall be posted for 30 consecutive days as there is immediate risks to the health, safety, or personal rights of children in care.

Also, LPA Anomeh Eivazian informed the Program Supervisor, Carol Gregory to provide a copy of this licensing report dated 06/27/25 that documents 2 Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

The Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Carol Gregory.
REPORT END 3 of 3
NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Anomeh Eivazian
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/27/2025 01:37 PM - It Cannot Be Edited


Created By: Anomeh Eivazian On 06/27/2025 at 12:40 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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: PACIFIC AVENUE EDUCATION CENTER
FACILITY NUMBER: 198012408

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/27/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/01/2025
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision--(a)The licensee shall provide care and supervision as necessary to meet the children's needs. etc...

This requirement was not met as evidence by...
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Per Carol Gregory, Already reviewed safety and supervision guidance with staff involved, we are planning to meet with all staff within two weeks to review safety and supervision procedure. The ipad for sign in/out will be with a staff to know who sign in/out. Staff members will be assigned to designated areas in the playground to ensure
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Based on 4 staff interviews, video footage, on 06/24/25, child#1 went outside the school and came back to lobby unsupervised, approximately for 151 footsteps far between 4:24:07 PM to 4:29:07. This poses an immediate health, safety and personal right risk to the children in care.
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 adequate supervision, specially at the exit areas. A work order will be placed for install permanent two gates on the playground for additional supervision and safety. Safety will be reviewed with children.
A written declaration will be submitted to LPA by 07/01/25.
Type A
06/30/2025
Section Cited
CCR101223(a)(2)

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The licensee shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs
This requirement was not met as evidenced by...
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Per Carol Gregory,Already reviewed safety and supervision guidance with staff involved, we are planning to meet with all staff in two weeks to review safety and supervision procedure. The ipad for sign in/out will be with a staff to know who sign in/out. Staff members will be assigned to designated areas in the playground to ensure
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Based on 4 staff interviews, video footage, on 06/24/25, child#1 went outside the school and came back to lobby unsupervised, approximately for 151 footsteps far between 4:24:07 PM to 4:29:07. This poses an immediate health, safety and personal right risk to the children in care.
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 adequate supervision, specially at the exit areas. A work order will be placed for install permanent two gates on the playground for additional supervision and safety. Safety will be reviewed with children.
A written declaration will be submitted to LPA by 07/01/25.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Christina Gabelman
NAME OF LICENSING PROGRAM MANAGER:
Anomeh Eivazian
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/27/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2025


LIC809 (FAS) - (06/04)
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