198003202-4-14-2025-33-CC-CTUA-DFQSAZ-20250414134311

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198003202
Report Date: 04/14/2025
Date Signed: 04/14/2025 01:43:19 PM

Document Has Been Signed on 04/14/2025 01:43 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:	HACIENDA LA PUENTE USD/CALIFORNIA WEST HEADSTART		FACILITY NUMBER:	198003202
ADMINISTRATOR/ DIRECTOR:	ROSEMARIE CAMP		FACILITY TYPE:	850
ADDRESS:	1111 CALIFORNIA AVENUE		TELEPHONE:	(626) 933-5212
CITY:	LA PUENTE	STATE: CA	ZIP CODE:	91744
CAPACITY: 48	TOTAL ENROLLED CHILDREN: 16	CENSUS: 13	DATE:	04/14/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:10 AM
MET WITH:			TIME VISIT/ INSPECTION COMPLETED:	02:00 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 April 14, 2025, at 10:10 am, Licensing Program Analyst (LPA) Carolyn Tuba conducted an unannounced random annual inspection visit. LPA entered facility through the California West Elementary School’s front office and was instructed to walk over to the southeast side of the campus where LPA met with staff Elva Roman who is a qualified teacher and holds a Site Supervisor Permit. The classroom is a Head Start/State preschool program Room #K2. LPA spoke to Child Development Supervisor, Kathy Jarvey during the visit over the phone. LPA took a census of 13 children and 2 staff in care. The program operates as a Head Start & State preschool program. Child Development Supervisor was unable to facilitate the visit and Staff member assisted. Hours of operation: The days and hours of operation for the Head Start/State Preschool: Monday-Friday, 8:00 A.M.- 2:30 P.M. Location: The classroom is next door to a TK classroom which is not licensed by the Department and the shared playground is surrounded by a chain-link fence, separating it from the rest of the elementary school. The classroom has 2 child-size toilets that are in separate restrooms and 2 child-size sinks. There is also a work room and kitchen area with a staff restroom that is separated by a door. The chain-link fence which surrounds the classroom are kept locked during operating hours and are only unlocked when children are being dropped off and picked up. The children enter through one door and staff and children have access to an emergency exit door on the other side of the classroom. There is a playground which has a structure that is appropriate for ages 2 - 5 years of age and is cushioned with a padded material. There is also a swing set which is cushioned by sand. There are toys and gross page 1 of 4

NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Carolyn Tuba
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/14/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2025

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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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: HACIENDA LA PUENTE USD/CALIFORNIA WEST HEADSTART	FACILITY NUMBER: 198003202
	VISIT DATE: 04/14/2025

NARRATIVE

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motor equipment kept inside a storage unit. LPA did advise the Child Development Supervisor that 2 bikes were missing the rubber grips on the handlebars, and the seats were broken. During the visit the custodian removed them from the playground. (Tech violation was issued). LPA also inquired if there is a waiver for the use of the playground as according to staff there are staggered play schedules. Child Development Supervisor stated that the classroom has always shared the playground with either a Kindergarten classroom or currently Transitional Kindergarten (TK) classroom. She is inquiring to see if a waiver has been issued by the Department. LPA will also be reviewing again to see if there is a waiver on file, however LPA stated that if there is not one in place then the Administration needs to request with the schedules of outside time for each classroom. Staff however did state that they play outside at 9:00 am to 9:30 am and that TK and Kindergarten plays at 9:45 am and they do not comingle the preschool children. LPA did explain to the Child Development Supervisor that if the waiver is not in place and is not requested timely then the LPA will have to do a return visit and issue a citation.

All posting requirements were observed inside the classroom, on the Parent Board which is located on the wall adjacent to the door through which the children will enter however the California Child Passenger Safety Law (PUB 269) was not posted and LPA printed a new one for the facility to post. LPA viewed a copy of the monthly meal menu, which is posted inside and outside for parents to view. All food is provided by the School District. Children are served Breakfast at 8:00 am, lunch at 11:00 am and P.M. snack between 1:00-1:30 pm.

The classroom has a kitchen area which contains a small refrigerator. There is currently one (1) child who requires medication and is kept labeled "Medication" and locked in a cabinet in the classroom with a padlock. LPA observed medication which was not found to be expired and required paperwork was stored with the medication. LPA observed and inventoried First Aid Kit, which is kept in the cabinet labeled with a sign 1^st aid. The cleaning supplies are kept in the cabinet, which is out of reach of children, which is locked.

There is a carbon monoxide and smoke detectors that are connected to the elementary school and are tested by the school district through-out the year. The last annual maintenance on the Fire Extinguisher was on July 2, 2024. Last Fire Drill was documented and conducted April 2025.

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NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Carolyn Tuba
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/14/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2025

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: HACIENDA LA PUENTE USD/CALIFORNIA WEST HEADSTART	FACILITY NUMBER: 198003202
	VISIT DATE: 04/14/2025

NARRATIVE

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According to staff children bring water bottles from home for the use of drinking water and refills are provided by the use of water bottles and poured into pitchers with disposable cups for the children who forget or require refills throughout the day.

There is napping equipment kept in the Head Start/State program. Children nap and bring napping items from home on Monday and is sent home on Friday to be laundered. Napping cots are labeled with each child’s name and cots are sanitized each day.

Children’s records and Staff files were reviewed to ensure that Identification and Emergency form and a medical assessment are on file and were complete.

Director 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.

AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018, any person who works in a childcare facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers. LPA advised the licensee to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

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.

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NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Carolyn Tuba
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/14/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2025

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: HACIENDA LA PUENTE USD/CALIFORNIA WEST HEADSTART	FACILITY NUMBER: 198003202
	VISIT DATE: 04/14/2025

NARRATIVE

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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records.

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. Lead testing results must be posted until the next testing is completed.

Director 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.

There were no citations being cited at this time.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Staff, Elva Roman.

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NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Carolyn Tuba
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/14/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2025

LIC809 (FAS) - (06/04)

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