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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019354
Report Date: 11/14/2025
Date Signed: 11/14/2025 01:31:45 PM

Document Has Been Signed on 11/14/2025 01:31 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:BELLFLOWER III CHILD DEVELOPMENT CENTERFACILITY NUMBER:
198019354
ADMINISTRATOR/
DIRECTOR:
MAYRA RUBIOFACILITY TYPE:
850
ADDRESS:14527 BELLFLOWER BLVDTELEPHONE:
(562) 991-1681
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 40DATE:
11/14/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Mayra Rubio, SupervisorTIME VISIT/
INSPECTION COMPLETED:
01:45 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 11/14/25 Licensing Program Analyst (LPA) Alicia Mooberry conducted an unannounced Annual/Random inspection. LPA met with Facility Representative Mayra Rubio, Supervisor. LPA explained the purpose of visit and provided an Entrance Checklist form LIC 125. LPA was guided on tour of facility including 2 classrooms, bathrooms, kitchen, outdoor play area. This is a preschool program serving up to 48 children ages 2-Entry into kindergarten. The facility is located on campus of Church building and operates Monday - Friday from 6:15 AM to 5:45 PM.

Between approximately 9:50am and 10:30am all areas identified on the Facility Sketch were inspected. LPA observed the following classroom ratios: Room 1 (16 children and 2 staff), Room 2 (24 children and 4 staff) LPA observed teacher child ratios in compliance with regulation and proper supervision. All staff present have obtained fingerprint clearance and have been associated to the facility.

LPA observed telephone service, heating, lighting and ventilation to be satisfactory. Children have adequate cubby storage for their belongings. Napping cots are labeled with child's name and stored appropriately with bedding removed. The facility provides sheet to cover cot which are laundered weekly and as needed. Blankets are provided by parents.

LPA observed filtered drinking water from dispenser along with drinking cups readily available inside the classrooms. The water filter sensor signals when filter needs to be replaced. Per Supervisor, water and cups are taken outdoors during outdoor play time.

Age appropriate restrooms, sinks and toilets were inspected for good repair, water temperature, toilet paper, safety and sanitation. All available toilets and sinks are in operable condition. ---Page 1 - Report Continues

NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Alicia Mooberry
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2025
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 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)
Page: 2 of 4
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: BELLFLOWER III CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 198019354
VISIT DATE: 11/14/2025
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
LPA reminded Supervisor Mayra Rubio to always store items such as hand sanitizer, cleaners and similar items in inaccessible areas or locked cabinets. The indoor classrooms have surfaces were observed by LPA to be clean and safe, no tripping hazards observed. The classroom are set up to have areas that provided:Quiet and active play, Rest and relaxation, Eating and Napping. There are age appropriate toys and educational materials for children to use.

LPA inspected first aid supplies in each classroom and found to be incompliance. Carbon monoxide detectors were tested and found operable, LPA observed smoke detectors in classrooms, the 2A10BC fire extinguishers are present in the facility with service tag dated 3/24/25.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of albuteral/inhaler for child #1 and equipment/supplies, and reviewed child and Staff 2 and 3 (who administer medication) 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/.

The office is used as an isolation area for ill children, per Supervisor, children are provided a cot is needed for children to rest while they await the child's authorized representative.

The facility (indoor and outdoors) operates on the grounds of a Church building, however the facility has separate operations. The outdoor play areas are enclosed and surrounded by a gate that is at least 4 feet high. Areas around and under climbing equipment have material to cushion a fall. All play equipment, toys, materials and surfaces accessible to children appear to be age appropriate and toxic free. There is a large canopy that provides shade.


Meal menus are posted at least one week in advance and are visible to an authorized representative. The facility provides breakfast, lunch and AM and PM snacks. Food items in the refrigerator reviewed for availability, quantity, expiration dates and appropriateness for children in care. LPA observed the snack storage area (kitchen) appear to be in sanitary condition. LPA informed Site Supervisor to constantly assess expiration dates on food items that are removed from original packaging and document. LPA advised Supervisor to review FDA guidelines on Food Product Dating as it applies to the food items in facility.

LPA observed cleaning compounds kept away from food preparation area. No insecticides are kept in the facility. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are locked and/or inaccessible. --------Page 2 - Report Continues

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

DATE: 11/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: BELLFLOWER III CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 198019354
VISIT DATE: 11/14/2025
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
LPA observed Sign in sheets at entrance to Classroom 2, All children present were signed in by the authorized representative. A digital sign in and sign out system is currently being implemented.

LPA conducted a Children's Records Review for completeness and to ensure children have proper forms such as Identification and Emergency forms, Immunization records, Health History, Personal Rights, Parents Rights on file. The children's roster was available and current.

Staff Records were reviewed to ensure the following: Criminal record clearance or criminal record exemption, education credits, current CPR/First Aid and health preventative practices, proof of immunization against pertussis and measles and influenza and/or flu declination, Mandated Reporter training, LPA observed 3 out of 6 staff records reviewed have current EMSA approved Pediatric CPR and 1st Aid.

Mandatory forms for the children’s files and staff files, requirements for fire drills, earthquake drills (last drill October 2025) and documentation were discussed.

The Facility Representative 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.

LPA informed Supervisor to log onto web site www.ccld.ca.gov to access forms, regulations and quarterly updates. LPA verified that the lead testing was completed and in accordance to the Written Directives outlined in PIN 21-21.1-CCP. No exceedance were found.

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/tion-process.

There were no violations of Title 22 regulations observed during this facility inspection. Notice of Site Visit was given and needs to be posted for 30 Days.


Exit interview was conducted with Supervisor Mayra Rubio and a copy of Appeal Rights (LIC 9058) was discussed and provided
NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Alicia Mooberry
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2025
LIC809 (FAS) - (06/04)
Page: 4 of 4