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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021037
Report Date: 06/05/2024
Date Signed: 06/05/2024 04:04:34 PM

Document Has Been Signed on 06/05/2024 04:04 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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:MY ACADEMY PRESCHOOLFACILITY NUMBER:
198021037
ADMINISTRATOR/
DIRECTOR:		LIANNA NAVASARDYANFACILITY TYPE:
850
ADDRESS:302 W. FOOTHILL BLVDTELEPHONE:
(818) 331-4816
CITY:MONROVIASTATE: CAZIP CODE:
91016
CAPACITY: 58TOTAL ENROLLED CHILDREN: 58CENSUS: 55DATE:
06/05/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:46 PM
MET WITH: Director Lianna NavarardyanTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Cynthia Reyes conducted an unannounced case management Inspection to ensure the health and safety standards as required by the regulations governing child care centers are met. LPA met with Director Lianna Navarardyan whom the deficiencies were gone over that were observed on this date.

During a walk through of the facility where staff names, positions and census of children who were in the facility on this date was taken, LPA determined that two staff members (Staff #9 and Staff #10) are not fingerprint cleared. Per interview with the two staff members, both state they have been working with the children for over a month. LPA verified by reviewing the file of all staff that were present on this date. Also during file review, LPA observed that all staff are missing proof of immunization's (MMR/TDAP/FLU), as well proof of education/transcripts.

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 & safe.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director, Lianna Navarardyan.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/05/2024
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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Document Has Been Signed on 06/05/2024 04:04 PM - It Cannot Be Edited


Created By: Cynthia Reyes On 06/05/2024 at 02:48 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: MY ACADEMY PRESCHOOL
FACILITY NUMBER: 198021037

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/05/2024
Section Cited
CCR
101170(e)(1)

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Criminal Record Clearance: All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility. (1) Obtain a California clearance or a criminal record exemption as required by the Department or (2) Request
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Director had the 2 staff members leave the facility and they will not return until they are fingerprint cleared. Director will submit in writing how they will ensure all staff are fingerprint cleared and associated before they start working at the facility. Director will email proof that the 2 staff are cleared.
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a transfer of a criminal record clearance. This requirement is not met as evidenced by: LPA observed during file review and staff names taken, staff #9 & #10 are not fingerprint cleared to this facility. This poses an immediate risk to the health, safety, and personal rights of child in care. A civil penalty is being assessed.
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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:Christina Gabelman
LICENSING EVALUATOR NAME:Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:
DATE: 06/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/05/2024


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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MY ACADEMY PRESCHOOL
FACILITY NUMBER: 198021037
VISIT DATE: 06/05/2024
NARRATIVE
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Type A citation
LPA Reyes informed Director, Lianna Navarardyan that this report dated 06/05/2024 document(s) (1) Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Reyes informed the Director, Lianna Navarardyan to provide a copy of this licensing report dated 06/05/2024 that documents any Type A citation(s) 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.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 06/05/2024 04:04 PM - It Cannot Be Edited


Created By: Cynthia Reyes On 06/05/2024 at 03:14 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: MY ACADEMY PRESCHOOL
FACILITY NUMBER: 198021037

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/21/2024
Section Cited
HSC
1596.7995(a)(1)

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(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
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Director will obtain a copy of all staff immunization records and submit a declaration stating that all staff have proof of immunization in their file by POC date (06/21/2024)
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This requirement is not met as evidenced by record review that all staff files reviewed do not have immunization records (MMR/TDAP/FLU) which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
06/21/2024
Section Cited
CCR101216(g)

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A photocopy of the teacher's Child Development Permit as specified in (c)(3) above, or a photocopy of the teacher's transcript(s) documenting successful completion of required course work, shall be maintained at the center. This requirement is not met as evidenced by record review that
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Director will obtain a copy of all staff education records and submit a declaration stating that all staff have proof of education in their file by POC date (06/21/2024)
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staff are missing proof of education in their file. which poses/posed a potential health, safety or personal rights risk to persons 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:Christina Gabelman
LICENSING EVALUATOR NAME:Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:
DATE: 06/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/05/2024


LIC809 (FAS) - (06/04)
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