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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198012593
Report Date: 08/28/2025
Date Signed: 08/28/2025 12:40:33 PM

Document Has Been Signed on 08/28/2025 12:40 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:HOLLYDALE PRESCHOOLFACILITY NUMBER:
198012593
ADMINISTRATOR/
DIRECTOR:		KELLEY-KUHN, NANCYFACILITY TYPE:
850
ADDRESS:5511 CENTURY BLVD.TELEPHONE:
(562) 602-6900
CITY:SOUTH GATESTATE: CAZIP CODE:
90280
CAPACITY: 25TOTAL ENROLLED CHILDREN: 25CENSUS: 20DATE:
08/28/2025
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Rita CruzTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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On August 28, 2025 at 9:10 a.m., Licensing Program Analyst (LPA) Peter Bishop arrived at the above facility for the purpose of an unannounced Annual Inspection. LPA Bishop announced the purpose of the visit and was granted entry into the facility by Director - Rita Cruz. There are 11 children enrolled, and 8 children present, and 3 staff present at the time of inspection. This is a State preschool program that consists of one classroom. Facility operating hours for children are Monday to Friday from 7:50am to 10:50am (AM program) & 12:00PM to 3:00PM (PM program). LPA observed all posting requirements for operation on the licensing board LIC 203A-License, LIC 610, PUB 393, PUB 269, LIC 9148, LIC 613A, Menus, Activity Schedule, and completion testing and remediated lead exceedances.
Documentation of current Fire & Earthquake drill was observed with last drill conducted on 05/22/2025.
Fire extinguisher(s) observed with a service tag date of 07/2026.

LPA observed an operable smoke detector, and carbon monoxide detectors.

LPA inspected the Classroom - the classroom was equipped with age-appropriate furniture and learning materials. Classroom has carpeted area, sink, soft furnishings, cubby storage for shoes, age-appropriate toys. The facility uses children use cups bought from home as a water source. The bottles are refilled throughout the day via water filter from classroom sink. The bottles are also taken outside during outdoor play. The children do not nap because the program is three hours. The First Aid supplies were inventoried in classroom first aid case. Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. Director states there are no poisons stored at the facility. LPA observed classroom, equipment, and materials to be in good condition, free of sharp, loose, or pointed parts.
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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Peter Bishop
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2025
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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: HOLLYDALE PRESCHOOL
FACILITY NUMBER: 198012593
VISIT DATE: 08/28/2025
NARRATIVE
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The bathrooms are located outside and there is a male and female bathroom with age-appropriate sinks and 2 toilets in each. The bathroom was in good working condition.

The Playground area has canopy for shade, small climbing structure, small slide, bikes, balls a soft surface throughout the area where the climbing structure is. There are age-appropriate tables and chairs. LPA observed main care area to be in good condition, free of sharp, loose, or pointed parts.



All electrical outlets are covered.

All trash cans have lids.

Kitchen is located in the in the Elementary school while staff distributes lunch.

LPA Bishop observed sign in and out sheets for 8/28/25 they are hand written. All signatures were accounted for.

The facility was reminded that smoking is prohibited on the premises.

The isolation area is Room B and if there is a sick child the child is accompanied by a teacher until the parent arrives.

The Director stated they do not administer medication to at this time.



The facility uses a landline. The facility also communicates with parents via Parent Square App.

The Director stated there are no firearms at the facility.

The Director stated that they do not provide transportation for children.

There are no bodies of water on premises.

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Peter Bishop
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: HOLLYDALE PRESCHOOL
FACILITY NUMBER: 198012593
VISIT DATE: 08/28/2025
NARRATIVE
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Staff Files

LPA did not review staff files during the inspection due to the staff files being stored at the administrative office. LPA will review staff files at a later time and date.

Child Files

Child #1


All required licensing forms, and Immunization records.

Child #2


All required licensing forms, and Immunization records.

Child #3


All required licensing forms, and Immunization records.
Child #4
All required licensing forms, and Immunization records.

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.

Criminal Record Clearance - Child Care Centers- Director - Rita Cruz 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

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Peter Bishop
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: HOLLYDALE PRESCHOOL
FACILITY NUMBER: 198012593
VISIT DATE: 08/28/2025
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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.

Lead Testing

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 child care 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). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Incidental Medical Services (IMS)

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, a Plan for Providing 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: https://www.ada.gov/resources/child-care-centers/.

MyChildCarePlan.org

Director - Rita Cruz was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

There were no deficiencies cited during today’s inspection.

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

Appeal rights reviewed and given to the Director - Rita Cruz

Exit interview conducted and report was reviewed with the Director - Rita Cruz





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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Peter Bishop
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
LIC809 (FAS) - (06/04)
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