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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019176
Report Date: 07/03/2024
Date Signed: 07/03/2024 02:07:43 PM

Document Has Been Signed on 07/03/2024 02:07 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:BRIGHT FUTURE MONTESSORI INC INFANT CAREFACILITY NUMBER:
198019176
ADMINISTRATOR/
DIRECTOR:
SYUZANNA JEREJYANFACILITY TYPE:
830
ADDRESS:1911 WALTONIA DR.TELEPHONE:
(818) 309-4422
CITY:MONTROSESTATE: CAZIP CODE:
91020
CAPACITY: 21TOTAL ENROLLED CHILDREN: 21CENSUS: DATE:
07/03/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:07 PM
MET WITH:Syuzanna Jerejyan TIME VISIT/
INSPECTION COMPLETED:
02:45 PM
NARRATIVE
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Licensing Program Analysts (LPA) Shushanik Safaryan conducted an unannounced Case Management inspection for the purpose for the following up on an unusual incident report. Upon arrival at 1:00 pm, LPA met with Facility Representative , Syuzanna Jerejyan ,to whom the purpose of the inspection was explained. Tour of the facility was provided. During the inspection 7 children were present with 3 staff members .

On 06/27/24 an unusual incident report was submitted to the Department regarding a child sustaining an injury on the facility grounds. Child tripped and bumped his forehead on the side of the wall in the classroom. Child was taken to the urgent care by a parent where stiches were placed.

During the visit , LPA conducted tour of the classroom . obtained pictures of where the injury took place. LPA observed cushioning material on the side of the wall , which per staff members was there from the beginning. Per Director , it gets replaced every time . During the visit LPA conducted Interviews with three staff members present during the incident and watch the video of the incident .Based on the interviews both staff members observed the incident . After review of information and video of the incident , there were no obstructions or defects in the classroom. Child was attended it immediately by staff, first aid was provided to the child, parents were notified, and an ouch report was created for the child on the day of the injury (obtained during today's inspection). Per Director she will add additional cushioning on the side of the wall .

Based on the information obtained and observation , LPA determined that there was adequate supervision on the day of injury, and it was not possible to prevent the injury from happening. Per California Code of Regulations Title 22, Division 12, no deficiency cited during today's visit.

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.

Exit interview conducted with the Director and Copy of Report provided.

END OF REPORT

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE: DATE: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/03/2024
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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