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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021483
Report Date: 06/26/2024
Date Signed: 06/26/2024 03:12:13 PM

Document Has Been Signed on 06/26/2024 03:12 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:EVERGREEN MONTESSORI ACADEMYFACILITY NUMBER:
198021483
ADMINISTRATOR/
DIRECTOR:
DR. KRISTINE VARDANYANFACILITY TYPE:
860
ADDRESS:2038 E FOOTHILL BLVDTELEPHONE:
(626) 460-0468
CITY:PASADENASTATE: CAZIP CODE:
91107
CAPACITY: 112TOTAL ENROLLED CHILDREN: 112CENSUS: 36DATE:
06/26/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Dr. Kristine VardanyanTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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On 06/26/2024 at 10:00 am, Licensing Program Analysts (LPAs), Crystal Green, Elka Chavez, and Priscilla Ochoa conducted an announced Pre-Licensing inspection to add a new Infant Program to an existing preschool with toddler option program (198021182) and convert both program into a new Single License. Upon arrival, LPAs met with Applicant Representatives, Dr. Kristine Vardanyan and Rosangelica Gonzalez.

This location is currently licensed to care for (52) children: (40) Preschoolers from ages 2 to 6 in classrooms pre-primary and primary and (12) Toddlers in the toddler classroom. The Applicant, AKO Corp., is requesting to be licensed for a total new capacity of 112 children by adding a new Infant program with a requesting capacity of (60) to the existing licensed capacity of 52 children.

This location will have three separate Buildings: Building A, Building B and the Preschool Building. Building A will house the new infant program in (2) classrooms: classroom 1 and 2. Building B will house (2) classroom 3 and 4. Classrooms 1 and 2 will serve ages 0 to 12 months and Classrooms 3 and 4 will serve ages 12 to 24 months. Preschool Building (main building) will house the existing preschool classrooms with toddler option in (3) classrooms: Pre-Primary, Primary and Toddler classroom. Hours of operation will be Monday to Friday from 7:00 am to 6:00 pm.

The front of this facility is accessible from East Foothill Blvd. There is an additional entry which is accessible from Walnut Street. This is also where the facility parking lot is located. Per Director, the parents of toddler will use this entrance to avoid commingling. Parents of Preschoolers will also have access to this entrance. The existing facility has an approved waiver on file allowing toddlers to cross through the designed preschool yard in order to reach the entrance of the toddler classroom.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE: DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/26/2024
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: EVERGREEN MONTESSORI ACADEMY
FACILITY NUMBER: 198021483
VISIT DATE: 06/26/2024
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All indoor and outdoor activity space utilized for the children was inspected today. LPA informed Rosangelica Gonzalez that staff are required to maintain direct visual supervision of the children at all times during indoor and outdoor activities. When medications are on site, Rosangelica Gonzalez stated that they will be in Directors Office in the locked drawer.

A fully equipped first aid kit is located throughout the facility. There is an operational carbon monoxide detector on site located throughout the facility. All required licensing documents were observed posted outside of the Infant classroom. Children will be signed in and out at classroom entrance using the ProCare app.

Total new infant indoor activity space measured for 1,992.54 square footage, which can only accommodate 56 infant children at one time. The toddler indoor activity space will remain at 455.50 square footage, which can accommodate the licensed capacity of 12. The preschool indoor activity space will remain at 1,417.74 square footage, which can accommodate the licensed capacity of 40. LPAs observed all hazardous items to be inaccessible to children. There are no bodies of water or weapons on the property. Fire clearance was granted on 4/30/2024.

In the infant room feeding tables have broad-based legs, plastic seats are in good repair and trays lock onto chairs. Changing tables have at least 1” padding covered with moisture-resistant, washable material. Sides of the changing table are at least 3” high and the changing table is within arm’s reach of a sink. Diapering sink is not used for meal preparation or dishwashing. Cribs meet regulatory requirements. Crib area is separated from activity space via built in glass wall. This barrier was observed to reach from the floor to the ceiling, made of sound absorbing material and allows for supervision of napping children. Sleep logs will be maintained on the countertop near the crib area. Needs and Services Plans and Sleep Plans are kept in the infant binder within the classroom.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024
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: EVERGREEN MONTESSORI ACADEMY
FACILITY NUMBER: 198021483
VISIT DATE: 06/26/2024
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LPAs observed the new infant program to have a total of 4 sinks and 4 toilets available for children’s use. Classrooms 1 and 2 were observed to have changing tables located within arm’s reach of a sink.

Facility will be providing am/pm snacks and parents will have the option purchase lunch for their child through a third-party vendor. Per Applicant Representative, for children ages 0 to 12 months parents will provide formula, drinking water, and snacks for their child. LPAs observed each infant classroom to contain a refrigerator, sink, bottle warmers, and prep countertop.

This facility currently has (2) existing play yards designated for the preschoolers and toddlers. The yards were observed to be separate from one another. The licensee has since added (3) additional play yards that will be designated for the infant program called Playyard 1, 2, and 3. Fencing is made of vinyl which is at least four feet high. The total square footage for the new infant outdoor activity space measured for 2,887.86 square feet, which can only accommodate 38 infants at one time. A playground waiver to share the playground at different times in the AM and PM due to limited square footage shall be submitted and approved prior to licensure. Shade is provided via shade canopies. There are sufficient outdoor age-appropriate toys and play equipment available on the playground. There is a climbing structure on the playground for children ages which is properly anchored. There is adequate cushioning in fall zones of climber. Drinking water is available via filter water jug. LPA observed all hazardous items on the playground to be inaccessible to children. Applicant Dr. Kristine Vardanyan and Rosangelica Gonzalez was reminded that any changes to the facility must be reported to and approved by Community Care Licensing.
For child care 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).

Applicant Representative, Dr. Kristine Vardanyan and Rosangelica Gonzalez was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: EVERGREEN MONTESSORI ACADEMY
FACILITY NUMBER: 198021483
VISIT DATE: 06/26/2024
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This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A 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) or (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 discussed the safe sleep regulations with licensee 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. LPA also informed [applicant, licensee, or 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.

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

During this inspection, LPA Green consulted with the applicant representative regarding submitting a waiver request. The Applicant Representative, Dr. Kristine Vardanyan and Rosangelica Gonzalez, was informed that the waiver request will be reviewed by the Regional Office for final approval in order to obtain the overall capacity of 108 children.

No corrections are needed. Upon a final file review and approval of the outdoor waiver request, a license for 108 children (56 infants, 12, toddlers, and 40 preschoolers) will be granted.

Exit interview conducted and report was reviewed with the Applicant Representatives, Dr. Kristine Vardanyan and Rosangelica Gonzalez.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4