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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015236
Report Date: 06/03/2024
Date Signed: 06/03/2024 03:27:25 PM

Document Has Been Signed on 06/03/2024 03:27 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:PENNSYLVANIA AVENUE MONTESSORI INFANT CAREFACILITY NUMBER:
198015236
ADMINISTRATOR/
DIRECTOR:		SONDRA WISEFACILITY TYPE:
830
ADDRESS:3966 PENNSYLVANIA AVENUETELEPHONE:
(818) 249-6618
CITY:LA CRESCENTASTATE: CAZIP CODE:
91214
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 7DATE:
06/03/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Marita MonfaredTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 06/03/2024, at 08:30 am ,Licensing Program Analyst (LPA) Shushanik Safaryan conducted an unannounced annual random inspection. Upon arrival ,LPA met with Facility Representative ,Marita Monfared, Assistant Director , who guided the LPA on a tour of the facility. This is an infant program which operates Monday through Friday from 06:30 am to 6:00PM. There is also preschool program on the premises with facility number 198015235. Infant Program consists of 2 classrooms. Per Facility Representative there are 20 children enrolled. Director Sondra Wise came in later .
LPA observed all required forms/publications posted by the main entrance.
During the tour, LPA observed 7 infants with 3 staff members. Teacher child ratios were observed to be in accordance with Title 22 Regulations. Staff names were recorded. All children were observed to be under supervision, including visual supervision. Licensed facility is within the conditions, limitations, and capacity specified on the license.

The classrooms furniture and equipment were inspected for good repair, free of sharp, loose, or pointed parts. Furniture and equipment are age appropriate for height and size of infants. All classrooms were inspected to ensure that the floors have a surface that is safe and clean. All materials and surfaces accessible to children are toxic free. Each infant has labeled storage for its belongings. Infants have sufficient changes of clothing and diapers to be always clean and dry. Diaper changing area is clean and within arm's length of a sink with running water and dispensable soap. Diaper changing area has a padded surface of no less than one inch thick and is covered with washable vinyl or plastic. Sides are raised at least 3 inches to present the infant from rolling off the mat. Soiled diapers are sealed in plastic bags and dispose of in a trash can .
Napping equipment and bedding was inspected for good condition, appropriate storage, and cleanliness. Cribs and cots are used for napping and for younger infants are placed in a room separate from the activity area. Infants able to pull themselves up ,sleep on mats.
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SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE: DATE: 06/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/03/2024
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PENNSYLVANIA AVENUE MONTESSORI INFANT CARE
FACILITY NUMBER: 198015236
VISIT DATE: 06/03/2024
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Cribs used by younger infants . Mattress is at its lowest position and side rail cannot be lowered. Mattress is covered with vinyl or similar moisture resistant material. Bedding is replaced when wet or soiled or when being occupied by another infant. Parents take linens home on Friday and returned on Monday.
LPA reminded Facility Representative cots and cribs need to be arranged to provide a walkway and workspace between the cribs or cots without staff having to step over or reach over other infants.

LPA observed that there are functioning smoke and carbon detectors in the facility. LPA observed a fully charged and serviced fire extinguisher with the service date 11/09/23. Emergency disaster drill was last conducted on 04/02/24. Facility Representative states there are no weapons, firearms, or bodies of water on the premises.

Bottles and food are brought from home. Older infants may eat meals and snacks prepared by the facility. Bottles and food brought from home labeled with the infant’s name. Small refrigerator is used for storing food items and perishables. Microwave oven is used for warming up foods while bottles are warmed up in bottle warmers.

First aid kit located in the kitchen.

All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair. Trash cans used to discard food have tight fitting lids. Drinking water is readily available indoors , children bring their own water bottles too. Per Facility Representative children take their water bottles outside during the outdoor play . The facility was observed to be free of flies, other insects, and rodents.

The staff room office or entrance area and staff restroom are used for the ill children. There is a sofa available for an ill child.

Outdoor playground equipment is in safe condition, free of sharp, loose, or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards . Tot turf is used as cushioning material under a play structure and throughout majority of the yard. A large tree provides adequate shade in the play yard.



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SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2024
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PENNSYLVANIA AVENUE MONTESSORI INFANT CARE
FACILITY NUMBER: 198015236
VISIT DATE: 06/03/2024
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Sign in and out sheets were reviewed to ensure that the person who signs the child in and out uses their full legal signature and records the time of the day. LPA observed sing in sheets by the main entrance .

At 10:00 am , Children’s Records were reviewed for completeness. LPA reviewed 7 children records and observed missing Notification of Parents Right (LIC 995) and Health Report forms (LIC 701) . An Inspection of required forms was made and documented on the LIC 857.

At 10:30 am LPA reviewed 3 infant staff records; Staff #1 and Staff #2 were missing immunization , Staff #3 have expired Mandated Reporter Certificate .

Criminal Records Clearance for adults and verification of CPR/First Aid and health preventative practices documentation was reviewed.There is at least one person trained in CPR and Pediatric First Aid present during this inspection. The review of Staff records was documented on the LIC 859. LPA reminded licensee staff present need to renew AB 1207 Mandated Reporter Training certificates every two years .

AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018, any person who works in a childcare facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers.

SB792 (Immunization Requirements for Staff and Employees) was discussed with the Director Assistant .

Incidental Medical Services (IMS) policy was discussed. Per Assistant Director IMS is not provied as this time. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice(USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA advised the licensee to access forms, regulations, and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.


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SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2024
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PENNSYLVANIA AVENUE MONTESSORI INFANT CARE
FACILITY NUMBER: 198015236
VISIT DATE: 06/03/2024
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LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

During the visit at 09:25 am Facility was not able to provide to LPA infant 15 minutes checks . LPA discussed with the licensee regulations regarding infants 15 minutes checks requirements . LPA provided regulations to the Assistant Director .Per Facility Representative they were checking on the infants but not recording .
During the visit LPA also discussed with the Assistant Director and Director infant ratios and regulation was provided .
LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Facility Representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Facility Representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.



For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP)
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SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2024
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PENNSYLVANIA AVENUE MONTESSORI INFANT CARE
FACILITY NUMBER: 198015236
VISIT DATE: 06/03/2024
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LPA verified that the lead testing was completed in accordance with the Written Directives outlined in PIN 21-21.1-CCP. During the visit ,LPA obtained paperwork for lead testing .

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.



Based on the LPA’s observations and records reviews, the following deficiencies listed on the attached LIC 809D(Deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health and safety.

An exit Interview was conducted, a copy of this report along with Notice of Site visit , Deficiency pages and Appeal Rights were explained and provided to the Facility Representative , Marita Monfared on 06/03/2024.

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.

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SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/03/2024 03:27 PM - It Cannot Be Edited


Created By: Shushanik Safaryan On 06/03/2024 at 01:57 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: PENNSYLVANIA AVENUE MONTESSORI INFANT CARE
FACILITY NUMBER: 198015236

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/03/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations ,interview and records review the licensee did not comply with the section cited above, during the review staff #1 and Staff # 2 , were missing proof of immunization , which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/24/2024
Plan of Correction
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By Director proof of immunization will be submitted to teh LPA by POC date .
Type B
Section Cited
CCR
101429(a)(2)(C)
Responsibility for Providing Care and Supervision for Infants
(C) Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations , interviews and records review the licensee did not comply with the section cited above. Per Facility Represantative they were not recording 15 minute checks ,] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/17/2024
Plan of Correction
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Per Facility Represantative , facility will create a form and staff will be notified and starting today 06/03/24 faicility will record 15 minute cheks and provide to LPA by POC date .
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 Guangorena
LICENSING EVALUATOR NAME:Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:
DATE: 06/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/03/2024


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