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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016502
Report Date: 05/14/2026
Date Signed: 05/14/2026 05:02:39 PM

Document Has Been Signed on 05/14/2026 05:02 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:BEYOND THE CLASSROOM, INC.FACILITY NUMBER:
198016502
ADMINISTRATOR/
DIRECTOR:		SAMANTHA MONTESFACILITY TYPE:
840
ADDRESS:304 PASADENA AVENUETELEPHONE:
(323) 449-4058
CITY:SOUTH PASADENASTATE: CAZIP CODE:
91030
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 6DATE:
05/14/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Samantha Montes, DirectorTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
NARRATIVE
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On May 14, 2026, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced Case Management- Incident inspection at the above facility. LPA met with director, Samantha Montes who guided LPA on a tour of the facility. LPA observed 6 children with 3 staff members.

The purpose of the inspection is to follow up on 3 incidents the facility reported to the department in a timely manner.

During the investigations, LPA interviewed Staff #1 (S1) to Staff #4 (S4) (S4 was interviewed on 04/30/26), LPA interviewed Child #1 (C1) to Child #2 (C2), and LPA obtained a copy of the facility roster.

Incident #1: Per S1, they observed on the facility cell phone C1 being recorded in the restroom by C2. Per S2, the incident was brought to their attention by S1. S2 stated they observed the video of C1 using the restroom. Per C1, C2 recorded C1 while C1 was using the restroom. Per S2, they immediately deleted the video from the facility cell phone. Per S2, they spoke with both children and notified both parents. Per S1, S2, and S4 children are directly supervised when using the facility cell phone. However, in regards to this incident, C1 and C2 were unsupervised with the cell phone in the restroom.

Incident #2: Per S1, they observed C1 and C2 playing in the playhouse outside and heard a nervous laugh from C1. Per S1, they had just turned around to assist another child with a spill. S1 stated, when they turned around to check on the laugh, they observed C2 quickly move their hands. Per S1, they asked C1 and C2 what happened and both children stated nothing. Per S1, they spoke with C1 in a private setting who stated C2 had touched their penis. S2, S1 brought the incident to their attention.
NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Monique Jessica Ayala
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/14/2026
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 4
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: BEYOND THE CLASSROOM, INC.
FACILITY NUMBER: 198016502
VISIT DATE: 05/14/2026
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S2 stated they spoke to C1 and C2 about the incident and C1 and C2 disclosed they were playing family with C1 being the dog and C2 being the owner. Per C1, C2 stated that dogs do not know how to pee so their private area needs to be pinched in order to pee. Per C1, C2 did not touch C2 underneath their clothing. Per S2, they notified parents. In regards to this incident, there was no staff member that observed the incident and the staff were informed of what happened by questioning C1 and C2.

Incident #3: Per S2, they were informed by S3 that C1 and C2 had eaten an unknown substance from the freezer. Per S3, they had just arrived from picking children up from school and C1 and C2 informed S3 that their stomachs were hurting. Per S3, they asked C1 and C2 what happened and they stated they ate something from the freezer. Per S3, they observed a substance in a paper cup in the freezer that stated "do not remove". Per S3, the children at the facility are fascinated by creating and freezing experiments. Per S2, they contacted poison control and notified C1 and C2 parents of the incident. Per S3, there are no known products at the facility that are toxic and does not know what exactly was in the mixture. Per S3, they were not here when C1 and C2 entered the kitchen and got a hold of the frozen substance. Per, C1 and C2 there was no one with them when they entered the kitchen/office area.

During the inspection, LPA observed on multiple occasions children coming/going to areas without staff supervision. LPA also observed children walking through the parking lot when being dropped of while S3 was still at the van. LPA informed all staff that supervision is required at all times.

Based on interviews conducted and observation. The facility is being cited 1 Type A deficiency in accordance with Title 22 Regulations, see LIC809D. LPA Monique Ayala informed assistant director, Jessica Amaya that this report dated 05/14/2026 document(s) 1 Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. Also, LPA Monique Ayala informed the assistant director to provide a copy of this licensing report dated 05/14/2026 that documents any Type A citation to parents/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 (LIC 9224), or other written statement, must be placed in the child's file for verification

An exit interview was conducted and a copy of this report along with Notice of Site Visit was provided to Assistant Director, Jessica Amaya.
NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Monique Jessica Ayala
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/14/2026 05:02 PM - It Cannot Be Edited


Created By: Monique Jessica Ayala On 05/14/2026 at 04:51 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: BEYOND THE CLASSROOM, INC.
FACILITY NUMBER: 198016502

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/14/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/14/2026
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision: The licensee shall provide care and supervision as necessary to meet the children's needs. No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1).
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Create a zoning area for the staff and children. Having a meeting with the staff and children regarding supervision.
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Supervision shall include visual observation. This requirement was not met as evidence by: Based on interviews and observation, C1 and C2 have been unsupervised on multiple occasions and LPA observed children unsupervised during the inspection
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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.
Ana Chico
NAME OF LICENSING PROGRAM MANAGER:
Monique Jessica Ayala
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/14/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/14/2026


LIC809 (FAS) - (06/04)
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