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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198010494
Report Date: 05/25/2023
Date Signed: 05/25/2023 04:56:33 PM

Document Has Been Signed on 05/25/2023 04:56 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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:SOUTHLAND CHRISTIAN PRESCHOOLFACILITY NUMBER:
198010494
ADMINISTRATOR:RAMIREZ, BETTYFACILITY TYPE:
850
ADDRESS:16400 WOODRUFF AVETELEPHONE:
(562) 867-8594
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY: 84TOTAL ENROLLED CHILDREN: 84CENSUS: 72DATE:
05/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Lead Teacher Annabelle GardnerTIME COMPLETED:
05:10 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Austin Estrada and Jeanette Estrada conducted an unannounced annual required inspection at the above facility. LPA met with Lead Teacher Annabelle Gardner, who guided analysts on a tour of the facility. LPA provided the entrance checklist upon arrival.
The facility has four classrooms where care is provided. LPA observed 21 children with three teachers in room 3 and 51 children with four teachers in the lab room. Teacher child ratios were observed, and staff names recorded. The following was observed during the tour of the facility:
LPA toured classroom 3, classroom 4, classroom, 5 and the lab room. All classrooms were observed to be clean and in good repair. The floors were clean, and lighting was in operable condition. There were age-appropriate toys and equipment. LPA observed cubbies/storage area for children to store their personal belongings. Smoke detector and carbon monoxide detector were observed to be in operable condition. LPA observed Fire extinguisher indicated fully charged last serviced on 8/20/22. First Aid kit was observed and inventoried. LPA observed drinking water readily available in classroom 4 and classroom 5 but did not see drinking water readily available in classroom 3. Per staff #2 (S2) children go outside and use the water fountain if water is needed. LPA advised Lead Teacher that water needs to be readily available in each classroom. LPA observed disinfectants and cleaning solutions to be inaccessible to children in care in classroom 3, classroom 5, and the lab room. LPA observed cleaning supplies to be accessible to children in care in classroom 4 as the cabinet was not locked. LPA advised staff #3 (S3) that all cleaning supplies should be inaccessible to children in care.
LPA observed an unlocked door in classroom 4 that lead to the back of the preschool classrooms which contained a separate play area and storage sheds. Per Lead Teacher, this area is used occasionally. LPAs observed the storage shed door to be open and contain hazard materials such as cleaning supplies, inspect poison, paint, axes, and other machinery accessible to children. LPA advised Lead Teacher that the shed should be locked and items in the shed should be inaccessible to children ion care. Lead Teacher immediately locked the shed. Per lead teacher, the kindergarten class from the elementary school that is on the same premises and walks through the licensed preschool playground to get to their classrooms. The elementary school children also share the same bathrooms as the licensed facility.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Austin Estrada
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2023
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 14
Document Has Been Signed on 05/25/2023 04:56 PM - It Cannot Be Edited


Created By: Austin Estrada On 05/25/2023 at 03:59 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: SOUTHLAND CHRISTIAN PRESCHOOL
FACILITY NUMBER: 198010494

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/25/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101238(g)
Buildings and Grounds
(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above: LPAs observed cleaning supples, insect poisons, paint, axes in a open storage shed accessible to children in care which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/25/2023
Plan of Correction
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Lead teacher immediately locked the shed containing the hazardous items. Lead teacher is aware that the shed should remain locked.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Valarie Cook
LICENSING EVALUATOR NAME:Austin Estrada
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2023


LIC809 (FAS) - (06/04)
Page: 2 of 14
Document Has Been Signed on 05/25/2023 04:56 PM - It Cannot Be Edited


Created By: Austin Estrada On 05/25/2023 at 03:59 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: SOUTHLAND CHRISTIAN PRESCHOOL
FACILITY NUMBER: 198010494

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/25/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101239.2(a)
Drinking Water
(a) Drinking water from a noncontaminating fixture or container shall be readily available both indoors and in the outdoor activity area.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above: Room 3 did not have drinking water in the classroom. Children went outside to use the water fountain which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/25/2023
Plan of Correction
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Per lead teacher, Water will be provided to the children in room 3 via water bottles
Type B
Section Cited
CCR
101238.2(d)(2)
Outdoor Activity Space
(d) The surface of the outdoor activity space shall be maintained: (2) Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above: LPA observed lifted turf in the playground area. LPA also observed cement in the out door play area to be lifted around a tree which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/22/2023
Plan of Correction
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Turf and cement will be restored or made inacessible to children in care.
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:Valarie Cook
LICENSING EVALUATOR NAME:Austin Estrada
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2023


LIC809 (FAS) - (06/04)
Page: 3 of 14
Document Has Been Signed on 05/25/2023 04:56 PM - It Cannot Be Edited


Created By: Austin Estrada On 05/25/2023 at 03:59 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: SOUTHLAND CHRISTIAN PRESCHOOL
FACILITY NUMBER: 198010494

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/25/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238.2(g)
Outdoor Activity Space
(g) The playground shall be enclosed by a fence to protect children and to keep them in the outdoor activity area. The fence shall be at least four feet high.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above: LPAs observed a fence in the outdoor pay area to be unlocked, LPAs also observed the back outdoor play area near the sheds not be be fenced and seperated from the elementary school which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/22/2023
Plan of Correction
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A lock will be put onto the fencein the front outdoor play area. A partitican will be put up in the back outdoor area or area will be changed to off limits. Proof will be provided to LPA via email by POC due date.
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
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Based on record review, the licensee did not comply with the section cited above: no documentation was available for review regarding the water lead testing which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/22/2023
Plan of Correction
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Docuemntation of lead testing will be provided to LPA via email by POC due date.
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:Valarie Cook
LICENSING EVALUATOR NAME:Austin Estrada
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2023


LIC809 (FAS) - (06/04)
Page: 4 of 14
Document Has Been Signed on 05/25/2023 04:56 PM - It Cannot Be Edited


Created By: Austin Estrada On 05/25/2023 at 03:59 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: SOUTHLAND CHRISTIAN PRESCHOOL
FACILITY NUMBER: 198010494

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/25/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above: 8 out of 9 staff did not have proof of immunizations which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/22/2023
Plan of Correction
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Documentation of required immunizations will be provided to LPA via email by POC due date.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above: 9 out of 9 staff did not have a current mandated reporter training certificate which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/09/2023
Plan of Correction
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Mandated reporter training certificates will be provided to LPA via email by POC due date.
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:Valarie Cook
LICENSING EVALUATOR NAME:Austin Estrada
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2023


LIC809 (FAS) - (06/04)
Page: 5 of 14
Document Has Been Signed on 05/25/2023 04:56 PM - It Cannot Be Edited


Created By: Austin Estrada On 05/25/2023 at 03:59 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: SOUTHLAND CHRISTIAN PRESCHOOL
FACILITY NUMBER: 198010494

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/25/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(f)
Personnel Requirements
(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above: 9 out of 9 staff did not have a current CPR/ first aid certificate which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/08/2023
Plan of Correction
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CPR/first aid training certificate will be provided to LPA via email by POC due date.
Type B
Section Cited
CCR
101229.1(b)
Sign In and Sign Out
(b) The person who brings the child to, and removes the child from, the center shall sign the child in/out.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above: 27 out of 72 children were not signed in at the time of inspection which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/01/2023
Plan of Correction
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sign in sheets will be provided to LPA via email by POC due date. Lead teacher will provide a letter to the parents regarding signing in and out.
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:Valarie Cook
LICENSING EVALUATOR NAME:Austin Estrada
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2023


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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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: SOUTHLAND CHRISTIAN PRESCHOOL
FACILITY NUMBER: 198010494
VISIT DATE: 05/25/2023
NARRATIVE
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 LPA requested a review of the waiver. Per lead teacher they were not aware of a waiver and a waiver was not observed.
Appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, paper towels, and general sanitation. Per lead teacher, children and staff used the same restrooms in the lab room. LPA advised lead teacher that staff and children should not use the same restrooms.
Napping equipment and bedding were inspected and found to be clean and in operable condition. Per Lead Teacher, bedding sheets are taken home and washed weekly. Per Lead Teacher, the isolation area is located at the front reception desk area in the lab room. An isolated bathroom for ill children was observed. LPAs observed medication to be locked in a cabinet in the lab room inaccessible to children in care.
LPA toured the outdoor play area. Outdoor area was observed to have age-appropriate toys and materials for children. LPA observed the turf cushioning surrounding the play structures to be lifted which is a potential tripping hazard. LPA also observed the cement (blacktop) around a tree in the outdoor play area to be lifted with a crack in the cement large enough to potentially cause a tripping hazard. LPA advised lead teacher that the turf and cement should be maintained to prevent any possible injuries. Shade was observed in the outdoor area and water was observed to be readily available via water bottles which were labeled with children’s names. LPA also observed water fountains readily available for children in care. LPA did not observe any large bodies of water on the premises.
LPA observed the kitchen area, food preparation area, and food storage area to be clean and free of litter, rubbish, rodents, and/or any other vermin. LPA observed refrigerator to be clean and in operable condition. LPA observed items in the refrigerator not to be expired. Food that was not in the original packaging were sealed and labeled with an expiration date.
During the inspection, children present was observed to be treated with dignity and respect and free from corporal and/or unusual punishment.
LPA observed required posted documentation which included, Facility License, LIC610- Emergency Disaster Plan, Publication (PUB) 393- Notification of Parent Rights, PUB 269- Child Passenger Restraint System, LIC 613A- Notification of Personal Rights and Lunch/Snack Menus. All documents were observed at the entrance of the facility (lab room).
LPA observed Sign in/out sheets, LIC 9148 Earthquake Preparedness, Daily Activity Schedule, and Verification of Disaster and Fire Drills. Per lead teacher the last disaster and fire drill was conducted on 4/14/23. LPA advised lead teacher that disaster and fire drill should be completed at least once every six months and documented and made available during inspections.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Austin Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023
LIC809 (FAS) - (06/04)
Page: 12 of 14
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: SOUTHLAND CHRISTIAN PRESCHOOL
FACILITY NUMBER: 198010494
VISIT DATE: 05/25/2023
NARRATIVE
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 LPA observed 27 out of 72 children not to be signed in at the time of inspection. LPA advised lead teacher that children should be signed in at the time of arrival.
Children’s records were reviewed for LIC 613A- Personal Rights, Admission Agreement, Immunization Records, LIC 700- Identification and Emergency Information, LIC 701- Physician’s Report, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, and LIC 9221 (Parent Consent to Administer Medication). LPA did not observe LIC 9221 for two out of two children’s files that require medication.
Staff records were reviewed for approved Pediatric First Aid and CPR certification, staff qualifications, LIC 508-Criminal Record Statement, LIC 503- Health Screening Report, LIC 9052- Employee Rights, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, and LIC 9108- Statement of Child and Mandated Reporter Training Certificate. There is not at least one staff present with a valid CPR/ first aid. Nine out of nine staff members didn’t have mandated reporter training certificate. Eight out of nine staff did not have the required immunizations. Seven out of nine staff are missing the health screen report with Tuberculosis. LPA advised lead teacher that two staff members did not have the 12 required units available for review.
Lead Poisoning Facts Flyer (PUB 515) – All licensees (Child Care Centers) must provide the following flyer to parents and families upon enrolling or re-enrolling any child. PIN 21-21-CCP: Release of the Written Directives for Lead Testing of Water in Licensed Child Care Centers Per AB 2370.
Facility has not completed the required lead testing.
Please visit the Lead Toxicity Prevention and Water Testing Information website for additional information and resources regarding lead testing in licensed childcare centers by visiting the following weblink: https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information. For any additional questions, please email: CCCWaterTesting@dss.ca.gov.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.
LPA provided and discussed PIN 23-06-CCP Information Regarding Brightly Colored Fentanyl, Also Referred to as “Rainbow Fentanyl”.
Incidental Medical Services (IMS) policy was discussed. 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
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Austin Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023
LIC809 (FAS) - (06/04)
Page: 13 of 14
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: SOUTHLAND CHRISTIAN PRESCHOOL
FACILITY NUMBER: 198010494
VISIT DATE: 05/25/2023
NARRATIVE
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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
To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.
LPA provided information regarding the TSP program to lead teacher.
Lead teacher was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
Based on the LPA’s observations, interviews and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety. Deficiencies include one type A violation and eight type B violation. The lead teacher was provided with LIC 9224 Parent Acknowledgement of Report Received.
A copy of this report shall also be posted where the parent/guardian of children enter and exit the facility. Both the notice of site visit and licensing report shall remain posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon their return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled child for the next 12 months. A signed Acknowledgement of Receipt (LIC9224) shall be in each child’s file, acknowledging receipt.
A notice of site visit was given and must remain posted for 30 days. Failure to maintain posting as required will result in a $100.00 civil penalty. Exit interview was conducted and report was reviewed with the lead teacher. Appeal rights were discussed and provided to the lead teacher.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Austin Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023
LIC809 (FAS) - (06/04)
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