<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191597514
Report Date: 05/07/2025
Date Signed: 05/09/2025 10:32:18 AM

Document Has Been Signed on 05/09/2025 10:32 AM - 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:WASHINGTON SCHOOL-BELLFLOWER USDFACILITY NUMBER:
191597514
ADMINISTRATOR/
DIRECTOR:		CRISTINA BLEVINSFACILITY TYPE:
850
ADDRESS:9725 E. JEFFERSON ST.TELEPHONE:
(562) 461-2227
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY: 60TOTAL ENROLLED CHILDREN: 45CENSUS: 16DATE:
05/07/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Deirdre Reyes, Director of Elementary Education TIME VISIT/
INSPECTION COMPLETED:
04:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On Licensing Program Analysts (LPAs) Alicia Mooberry and Tyler Reyes conducted an unannounced Annual Random Inspection on this date. This facility is currently licensed for capacity of 60 children and is located on the campus of Washing Elementary School. Licensing staff met with Deirdre Reyes, Director of Elementary Education, who allowed entry in to facility. The program currently operates two classroom, #908 and #909, service is provided morning and afternoon session. Morning class from 8:30 AM to 11:30 AM and Afternoon class is 12:30 PM to 3:30 PM. LPAs toured the facility both indoors and outdoors. LPAs reviewed the required postings on bulletin board by classroom entrance.

LPA observed 9 children and 2 staff in Room 908, 7 children and 2 staff in room 909. The facility is made up of two bungalows. LPA observed furniture and equipment were inspected for age appropriateness and good repair. LPA observed child size tables and chairs, learning stations with dramatic play toys, art materials, and math manipulative toys available for children in care that is well maintained and free of loose and sharp parts. Telephone service, heating, lighting and ventilation were evaluated. There were cubbies observed as storage for children's belongings. There is no napping equipment at the facility due to part time programs. LPA observed individual water bottles available for children in care. Staff confirmed that children bring their own water bottle from home. Additional filtered water is available. Age appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, area safety and sanitation. LPA observed one toilet and one sink in the bathroom and an additional bathroom and sink in the nurses office.

A first aid kit is kept in a backpack hanging by the entrance and was inventoried for supplies. LPA observed medications stored for one children in first aid backpack Room 909 that meet Tittle 22 Regulation requirements. Report Continues Page 1

NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Alicia Mooberry
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/07/2025
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)
Page: 2 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: WASHINGTON SCHOOL-BELLFLOWER USD
FACILITY NUMBER: 191597514
VISIT DATE: 05/07/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Carbon monoxide and smoke detectors are present in the facility. Fire extinguishers have been serviced on 07/2024. Disaster and fire drill log was posted and last drill was conducted on 4/25/25.

Snack menus were reviewed. Facility is provided AM and PM snack provided by the elementary school cafeteria.

Outdoor space and equipment was inspected for safety, cushioning material, good repair and age appropriateness. LPAs observed concrete court used by children. LPAs observed large play ground structure in good repair with rubber floor below to absorb fall. Required shade and fencing were inspected.

Staff was reminded that the children need to be within the direct care and supervision, including visual supervision of the teacher(s) at all times. The children have access to their water bottles for outside play. Play area was inspected for hazards and inaccessibility to bodies of water; no bodies of water or hazards observed.

All staff and employees have obtained a criminal record clearance or criminal record exemption as a condition of employment with the Bellflower Unified School District.

Teacher-child ratios were observed and staff names recorded. Care and supervision was evaluated to determine if the basic needs of children are met and appropriate. Sign-in and out process was evaluated. The facility has an electronic sign in and out policy. All children present were signed at time of inspection.

Children’s Records were not reviewed. Bellflower USD keeps confidential files for children in Admin office which includes Physician Report, Immunization Records, and TB risk assessment. Per Director, staff files are also kept in office. LPA will review files at a later time. Upon review, staff present had current Pediatric First Aid/CPR.



This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication for student 1 and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. 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 are available at: https://www.ada.gov/resources/child-care-centers/. Page 2--- Report Continues
NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Alicia Mooberry
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025
LIC809 (FAS) - (06/04)
Page: 3 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: WASHINGTON SCHOOL-BELLFLOWER USD
FACILITY NUMBER: 191597514
VISIT DATE: 05/07/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The facility representative was reminded 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.

Record review and facility representative confirmed the lead testing has not been completed, facility is in the process of testing. LPA observed drinking water bottles for in children's individual cubbies, labeled with their names. Per facility representative, children bring their own water and are provided filtered water if needed. LPA observed drinking fountains in each classroom and in the outdoor play area, this poses a potential risk to the health and safety of children in care. The fountains were covered and made inaccessible to children until the lead test is completed. LPA referred licensee to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

LPA advised of the requirement to report Unusual Incidents and/or injuries to the parent/guardian and to licensing in a timely manner.



1 B deficiencies is being cited as a result of this inspection.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Facility Representative Raquel Osuna, Director. Appeal rights were discussed and a copy provided.

NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Alicia Mooberry
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025
LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 05/09/2025 10:32 AM - It Cannot Be Edited


Created By: Alicia Mooberry On 05/07/2025 at 04:08 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: WASHINGTON SCHOOL-BELLFLOWER USD
FACILITY NUMBER: 191597514

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/07/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview and record review, the licensee did not comply with the section cited above in that the facility has not completed, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/07/2025
Plan of Correction
1
2
3
4
Per faciliy representative Deirdre Reyes, they are in the process of obtaining a vendor to conduct the lead test, the faciltiy has coveres the water fountains in the classrooms and in the playground making them inaccessible to children. Filtered drinking water is brought from home and provided by facility as needed.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Warren Birks
NAME OF LICENSING PROGRAM MANAGER:
Alicia Mooberry
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/07/2025


LIC809 (FAS) - (06/04)
Page: 5 of 5