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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021271
Report Date: 01/29/2024
Date Signed: 01/29/2024 04:08:00 PM

Document Has Been Signed on 01/29/2024 04:08 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:SOUTH WHITTIER ASSEMBLY OF GODFACILITY NUMBER:
198021271
ADMINISTRATOR:COMBS, TIMOTHYFACILITY TYPE:
850
ADDRESS:11924 LELAND AVETELEPHONE:
(562) 944-2577
CITY:WHITTIERSTATE: CAZIP CODE:
90605
CAPACITY: 15TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
01/29/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Timothy CombsTIME COMPLETED:
04:30 PM
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On 1/29/2024 at 1:30 pm, Licensing Program Analysts (LPAs), Crystal Green and Staicy Perry conducted an announced Pre-Licensing inspection for a new license. Upon arrival, LPA met with Applicant Representative, Cathy Combs and Timothy Combs. Applicant, South Whittier Assembly of God Church, has requested to be licensed for 15 preschoolers ages 3 to 5 years old. Hours of operation will be Monday to Friday from 6am to 6pm.

This facility will be located on the premises of South Whittier Assembly of God Church. All indoor and outdoor activity space utilized for the children was inspected today. LPA informed Cathy Combs that staff are required to maintain direct visual supervision of the children at all times during indoor and outdoor activities. When medications are on site, Cathy Combs stated that they will be stored in a cabinet located with kitchen area. A fully equipped first aid kit is located in within the classroom. There is an operational carbon monoxide detector on site located throughout the facility. All required licensing documents were observed posted next to the main entrance to the facility. Children will be signed in and out at the main entrance.

LPA continued to tour the facility and measured all indoor and outdoor activity space. This preschool program will have one classroom. Total indoor activity space measured 947.38 square footage, which is sufficient to accommodate the requested capacity of 15 children. LPA observed all indoor activity space to be complete with safe, age-appropriate furniture and equipment, including tables, chairs, cubbies, napping cots, bookshelves, and other activity supplies for the children. Drinking water will be available in the classrooms via water filter dispenser and children will have their personal sippy cup. LPA observed all hazardous items to be inaccessible to children. There are no bodies of water or weapons on the property. Fire clearance was granted on 11/16/2023 by the LA County Fire Department.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE: DATE: 01/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2024
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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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: SOUTH WHITTIER ASSEMBLY OF GOD
FACILITY NUMBER: 198021271
VISIT DATE: 01/29/2024
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LPA observed a total of 4 sinks, 4 toilets, and 1 urinal available for children’s use. These are sufficient to accommodate the requested capacity of 15 children. Licensing staff observed insufficient step stool available in the restroom to allow the toilet and sink to be age appropriate for children. There is a separate staff restroom equipped with a toilet and a sink. The isolation area for children who are ill will be the staff restroom.
Facility will provide AM/PM snacks and lunch. There is a fully functioning kitchen located on the premises which will be used to prepare food on site. The kitchen is located next to the classroom which will be maintained inaccessible to the children via closed child safety gate only staff will be allowed to have access to. The kitchen area currently includes refrigerator, sink, stove, oven, microwave, food prep countertop. The kitchen area and food storage areas were observed free of rodents and/or vermin. Food was observed to be properly stored separate from cleaning materials.

The facility currently has a fully fenced playground area. There are 2 separate designated play yards, front play yard and back main play yard. Fencing is made of wrought iron which was observed to be at least four feet high. LPA obtained measurements of the designated area which calculated to be 8818.12 square footage which can accommodate 15 children at one time. Shade is provided via canopy in the back main playground yard however the applicant will need to provide additional shade for the front play yard. Licensing staff observed the outdoor playground equipment to be in good condition however the play equipment was observed to have spider webs and dirt debris.

There are sufficient outdoor age-appropriate toys and play equipment available on the main playground area. There is a climbing structure and swing set on the playground for children ages 2 to 5 which is properly anchored. There is insufficient cushioning in fall zones of the swing set area of the playground. Drinking water will be available via water brita. LPA observed all hazardous items on the playground to be inaccessible to children. Applicant Representative, Cathy Combs, was reminded that any changes to the facility must be reported to and approved by Community Care Licensing.

For childcare 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).
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2024
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: SOUTH WHITTIER ASSEMBLY OF GOD
FACILITY NUMBER: 198021271
VISIT DATE: 01/29/2024
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Applicant representative 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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 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, available at: http://www.ada.gov/childqanda.htm

LPA reviewed with the applicant representative the LIC 311A, Records to Be Maintained at The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

Applicant Representative was informed of the MyChildCarePlan.org site, 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. 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 communications.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2024
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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: SOUTH WHITTIER ASSEMBLY OF GOD
FACILITY NUMBER: 198021271
VISIT DATE: 01/29/2024
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The following corrections are needed prior to the issuance of the license:
• Will need to clean playground equipment located in the back designated outdoor playarea.
• Will need to install additional shade in the front designated outdoor playarea.
• Will need to place cushioning in the swing set fall zone area on the back designated outdoor playarea.
• Will need to obtain 6 additional step stools to place in the restroom area to make equipment age appropriate for children’s use.
• Will need to submit documentation for Site Director.

Applicant Representative, Cathy Combs, understands that all proof of corrections must be provided to the Department within 30 days, or the application may be denied. A license with a capacity for 15 children will be granted upon a final file review.

Exit interview conducted and report was reviewed with the Applicant Representative, Cathy Combs.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4