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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021483
Report Date: 07/29/2025
Date Signed: 07/29/2025 02:40:08 PM

Document Has Been Signed on 07/29/2025 02:40 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: 108TOTAL ENROLLED CHILDREN: 93CENSUS: 71DATE:
07/29/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Director Rosie GonzalezTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On 7/29/25 at 10:15am, Licensing Program (LPA) Stephanie Li conducted an unannounced annual inspection. Facility address is located off of Foothill Blvd but facility parking lot and entrance in located at the back of facility off Walnut St. Main entrance is from parking lot off of Walnut St. Upon arrival, LPA met with Director Rosie Gonzalez and owner Kristine Vardanyan, who led LPA on a tour of the facility. This is a single license facility servicing infant, toddler and preschool age. There are currently 93 children enrolled. Census was taken. There were 71 children and 20 staff. Hours of operation are Monday-Friday from 7:00am-6:00pm.

All areas identified on the Facility Sketch were inspected. The facility consists of 6 classrooms, 3 children’s bathroom, 3 staff bathroom, kitchen, office, and 6 playgrounds. The following was observed: Infant room 1 (0-12mths) had 6 infants and 4 teachers, Infant-Toddler room 1 and 2 (12mths- 2 yrs) had 23 children and 8 staff, Toddler/prek option (2yrs-3yrs) had 11 children and 2 teachers, and preschool rooms 1 and 2 (3yrs and up) had 31 children and 4 staff. Teacher-child ratios were observed to be in accordance with Title 22 regulations. The Licensee is within the conditions, limitations, and capacity specified on the license. All children were observed to be under active/visual supervision of a teacher during the tour.

Licensing staff observed disinfectants, cleaning solutions, medication and other items that are dangerous to children were not accessible to children. Classroom furniture and equipment are in good condition, free of sharp, loose, or pointed parts. All floors are clean and safe. Storage for children's belongings were inspected. All toilets and washing facilities were inspected for safe and sanitary operating conditions.

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NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Stephanie Li
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/29/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: EVERGREEN MONTESSORI ACADEMY
FACILITY NUMBER: 198021483
VISIT DATE: 07/29/2025
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LPA observed food bibs and spoons in the diapering sink in infant Room 1. LPA advised that diapering sink may not be used for dish washing, food preparation or food washing. Sink that washes food trays, utensils, bibs, and other food or eating related tools need to be washed in an entirely different sink. There is only one sink in the infant room. LPA advised to wash food eating items, bibs, spoons, etc in a different sink. Per director, there is another sink in the unused infant room that staff can wash infant dishes in.

Licensing staff observed all required forms/publications to be posted on the parent boards. LPA advised for Emergency Disaster Plan to be updated with assigned emergency task per program (infant, toddler, prek) Emergency plan posted near classrooms should match the task of assigned teachers and evacuation locations. LPA reminded director to indicate emergency exits identified by NUMBER on the facility exit sketch. First Aid supplies are available and complete. There is an isolation area in the office for an ill child to rest. Drinking water is available and provided through filtered faucet.

Cribs, cots and napping equipment were observed in all classrooms. The infant nap area is in a completely separated room and a teacher was observed in there with infants while they were napping. LPA observed portable cribs that meet Consumer Product Safety Commission safety standards. Cribs were observed to be free of loose items. Cots were available for infants who can climb out of a crib. Per director, linens are brought home by parents to wash weekly, Facility has extras for children when needed. LPA observed that entry way to nap room wide enough for one crib to fit through and noticed all cribs are stored in nap room. LPA advised to store 2 evacuation cribs near emergency exits for easier access in case of emergency.

Diaper changing tables were inspected and observed to be within an arms reach of a sink with proper padding. Proper disinfecting was observed. There is at least one sink for every 15 children and 2 working toilets. Facility has waiver on file for changing table in toddler option not being within arms reach.

Per director, parents bring children’s bottles from home and bottles are sent home for washing. Facility serves am and pm snack. Parents pack lunches from home and have the option to sign up for catered meals at additional cost. Facility stores food accordingly as needed with proper labeling. Facility carries extra snacks in fridge as back up when more food is needed. 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. The facility was observed to be free of flies, other insects, and rodents. Page 2 of 4

NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Stephanie Li
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2025
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: EVERGREEN MONTESSORI ACADEMY
FACILITY NUMBER: 198021483
VISIT DATE: 07/29/2025
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Licensing staff observed a 2A10BC fire extinguisher last serviced on 3/11/25. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. Facility has a hard wired carbon monoxide and smoke detector that meets statutory requirements and unable to test. LPA did not observe any bodies of water on the premises. Per school log, the last disaster drill was conducted on 06/16/25.

Licensing staff observed the outdoor play area. Facility has waiver on file for infant playgrounds for staggered play times. Infants have staggered play schedules and outdoor yard schedule is posted on parent board. The playgrounds 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. All areas around or under high climbing equipment, swings, slides, and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard. Drinking water is readily available outdoors. When children need the bathroom or a diaper change, teaching staff will bring children inside for the restroom or director will step in to assist.

Sign in and out is conducted on the Procare app. Staff and children’s records were reviewed and documented on LIC857 and LIC859. Several teachers have current CPR/First aid. Exp 4/2026. Teachers have mandated reporter certificates. Sleep check logs are done on the Procare app.

Incidental Medical Services (IMS) is currently being provided for anaphylaxis care. 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

All medications and forms were reviewed for completeness. LPA observed epi-pens stored with original prescription box and anaphylaxis care plan.

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NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Stephanie Li
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2025
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: 07/29/2025
NARRATIVE
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Facility 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.

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.

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). Per director, lead testing was conducted 2 years ago.

Teacher 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.

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.

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, report was reviewed, and appeal rights were given to Director Rosie Gonzalez.

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NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Stephanie Li
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2025
LIC809 (FAS) - (06/04)
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