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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191501187
Report Date: 11/22/2024
Date Signed: 11/22/2024 03:23:34 PM

Document Has Been Signed on 11/22/2024 03:23 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:BETHANY PRESCHOOLFACILITY NUMBER:
191501187
ADMINISTRATOR/
DIRECTOR:		ROSEMARY LEONFACILITY TYPE:
850
ADDRESS:93 NORTH BALDWINTELEPHONE:
(626) 355-3527
CITY:SIERRA MADRESTATE: CAZIP CODE:
91024
CAPACITY: 90TOTAL ENROLLED CHILDREN: 90CENSUS: 0DATE:
11/22/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Tiffani Djeu - DirectorTIME VISIT/
INSPECTION COMPLETED:
03:35 PM
NARRATIVE
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Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced Case Management inspection to follow up on an incident reported to the Department on 11/20/2024. Upon arrival at 2pm, LPA met with Head of School John Hawes. Director Tiffani Djeu arrived soon after at 2:10pm. A tour of the facility was provided. There were no children present during time of inspection due to half day schedule.

On 11/19/2024, Child #1 was outdoors with their classroom, when they were unaccounted for as the class transitioned back to the class room. Child was left unattended on the facility play yard for approximately 17 minutes before another school staff member discovered them.

During today's inspection, LPA conducted an interview with the Head of School, obtained documents relating to the incident, and reviewed camera footage. Camera footage showed class lining up for transition to the classroom at 11am, on the day of the incident. Child was observed to be hiding in the play house that is on the play yard. At 11:17am, elementary school staff was observed entering the play yard area and discovered Child #1 without staff supervision. At 11:18am, Preschool staff was observed exiting a classroom to the play yard to retrieve Child #1.

Based on the information reviewed during the inspection and gathered from interview, LPA has determined that there was a Lack of Supervision violation that occurred. A deficiency is being cited in accordance with California Code of Regulation, Title 22 Chapter 1 Section 101229(a)(1) Responsibility for Providing Care and Supervision.

LPA Tcheng informed Director Tiffani Djeu that this report dated 11/22/2024 documents one Type A citation, which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, and personal rights of children in care.


REPORT CONTINUES PAGE 1 of 2
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2024
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 11/22/2024 03:23 PM - It Cannot Be Edited


Created By: Nolan Tcheng On 11/22/2024 at 02:57 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: BETHANY PRESCHOOL
FACILITY NUMBER: 191501187

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/02/2024
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision
(1) No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation.

This requirement is not met as evidenced by:
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Per Director, they have conducted 1 on 1 meetings/trainings with each staff member to go over new policies for successful transitions and adequate supervision (signed staff forms obtained). Director will have LIC9224 signed by authorized representatives by the next applicable day
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Based on interview and observation, Licensee did not ensure Child in care was under supervision, resulting in a child being left unattended on the facility play yard. This was an immediate risk to the health, safety, and personal rights of child in care.
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and send LPA a completed checklist of the families that have done it.

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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:Ana Chico
LICENSING EVALUATOR NAME:Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:
DATE: 11/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/22/2024


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: BETHANY PRESCHOOL
FACILITY NUMBER: 191501187
VISIT DATE: 11/22/2024
NARRATIVE
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Also, LPA Tcheng informed the Director to provide a copy of this licensing report dated 11/22/2024, that documents any Type A citation, to parent/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 (LIC9224), or other written statement, must be placed in the child's file for verification.

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

Exit interview conducted and report was reviewed with Director Tiffani Djeu, at 3:20pm. Plan of corrections was developed and Copy of Report provided.

END OF REPORT PAGE 2 of 2

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2024
LIC809 (FAS) - (06/04)
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