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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021431
Report Date: 08/05/2025
Date Signed: 08/12/2025 10:06:43 AM

Document Has Been Signed on 08/12/2025 10:06 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:SOUTH HILLS ACADEMYFACILITY NUMBER:
198021431
ADMINISTRATOR/
DIRECTOR:		ANASTA FACUNFACILITY TYPE:
860
ADDRESS:1600 E. FRANCISQUITO AVE.TELEPHONE:
(626) 919-2000
CITY:WEST COVINASTATE: CAZIP CODE:
91791
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 46DATE:
08/05/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Michelle Mendoza, Teacher,TIME VISIT/
INSPECTION COMPLETED:
04:55 PM
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Licensing Program Analysts (LPA) Cynthia Reyes conducted an unannounced annual site Inspection to ensure the health and safety standards as required by the regulations governing childcare centers are met for this Preschool program. LPA met with Michelle Mendoza, Teacher, and a copy of the Entrance Checklist for Child Care Centers form (LIC 125) was provided. The days and hours of operation are Monday to Friday from 6:30 AM to 6 PM. The facility is located on the campus of South Hills Academy that also host Elementary and High school students.

LPA began the tour of the facility with Teacher Michelle. The parents will enter and exit one gate from the main parking lot on the side of the building. The children sign in/out for the parents is in each of the classrooms. Sign in and out sheets were reviewed to ensure that the person who signs the child in and out uses their full legal signature and records the time of the day and census of each physical count of the children in care for the day. The parent board is located inside each class room with the licensing required postings and are visible for all to see. Facility has telephone service as well as an email and both were verified. The licensee was advised that the email may be public information.

The ill/isolation area is in the director’s office and the staff rest room is located main office. A cot/chair will be used for the ill child to use and rest if needed and away from the other children while waiting for the child to be picked up by the parent. Health checks are conducted in each class room by the staff each morning.
LPA was guided through the preschool classrooms #125-130. During the tour LPA took staff names, position and children's census.
NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Cynthia Reyes
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/05/2025
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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: SOUTH HILLS ACADEMY
FACILITY NUMBER: 198021431
VISIT DATE: 08/05/2025
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There is a bungalow that houses the Directors office and across from it is another building for all the class rooms and the play yard is in front of class rooms 125, 126, and 127.

· Room #125 consist of 0 teacher, 0 aide with 0 total children. (Room is not in use)
· Room #126 consist of 1 teacher, 0 aide with 9 total children. (An AB Therapist was also present)
· Room #127 consist of 1 teacher, 1 aide with 12 total children.
· Room #128 consist of 0 teacher, 0 aide with 0 total children. (Room is not in use)
· Room #129 consist of 2 teacher, 0 aide with 15 total children.
· Room #130 consist of 1 teacher, 0 aide with 10 total children.

Teacher child ratios were discussed in accordance with Title 22 Regulations and observed. LPA observed the licensed facility is within the conditions, limitations, and capacity specified on the license. LPA discussed Responsibility for Providing Care and Supervision that children should be under direct supervision and observation, including visual supervision, of a teacher at all times.

The following in the classrooms were also observed by LPA during this inspection. Toys and play equipment were observed to be age appropriate clean and safe. All surfaces and materials accessible to children, including toys, are toxic free, age-appropriate fixtures, furniture, equipment and supplies and all was inspected for age appropriateness and is in good repair. LPA observed and inspected napping equipment (cots) & are age appropriate and in good repair. Sheets/blankets are provided by the parents and taken home and washed every Friday. Appropriate Individual storage space was observed to be available for each child and cleanliness was observed in the room. LPA observed the facility has central heat and air, overhead lights as well as natural light. The facility will provide water by jugs and cups and the children can bring their own labeled water bottles/Sippy cups.

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NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Cynthia Reyes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025
LIC809 (FAS) - (06/04)
Page: 3 of 13
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: SOUTH HILLS ACADEMY
FACILITY NUMBER: 198021431
VISIT DATE: 08/05/2025
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LPA observed all restrooms used by children are in good condition, water temperature, paper towels, toilet paper, and all were inspected for safety, sanitation and operable. Childcare centers shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

Licensing staff was then guided to the outdoor play area. The outdoor play yard is self-contained by a gate around it. Water will be used by jugs, cups and children’s own water bottles while outdoors. LPA observed age-appropriate outdoor toys, play equipment and materials to be clean, safe and in good repair, as well as adequate shade available by use of large trees and canopy. All areas around play equipment and slides are cushioned with material to absorb a fall. LPA advised the licensee that the children need to be within the direct care and supervision, including visual observation and supervision of the teacher(s) at all times. No bodies of water were observed on the premise. All areas identified on the Facility Sketch were inspected.

Children food: The facility provides am and pm snack- parents have the option to bring lunch from home or order hot meals from the school cafeteria. Snack menus were observed to be posted and reviewed to ensure that they are being posted at least one week in advance and visible to an authorized representative. There is a full kitchen located on the premises with a cafeteria. Per the Applicant Representative, the cafeteria is not used by the preschool children. The kitchen area includes a refrigerator, sink, stove, fryer, microwave, and food prep counter top. The kitchen prep area was observed to be free of hazards. The kitchen and food storage areas were observed free of rodents and/or vermin. All food and drinks are to be labeled with the expiration date visible for all to see. Containers used to discard food have tight fitting lids. The facility has extra linen and food available if needed.

Carbon monoxide detectors and smoke detectors are present and are in operable condition in each classroom. Smoke and Carbon Monoxide detectors should be checked and batteries replaced as needed. The fire extinguisher type 2A-10BC (Service date: 02/03/2025) must be serviced annually or as often as necessary. Fire and earthquake drills must be done every 3 months and documented (Last drill 01/22/2025). Hazardous items including disinfectants, poisonous, cleaning solutions and any other items that could pose a danger to children were observed to be stored inaccessible to children.
NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Cynthia Reyes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025
LIC809 (FAS) - (06/04)
Page: 4 of 13
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: SOUTH HILLS ACADEMY
FACILITY NUMBER: 198021431
VISIT DATE: 08/05/2025
NARRATIVE
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Facility has No transportation policy. Licensee states that any lifesaving medication will be stored in a locked area inaccessible to children in care. First aid supplies were observed to have all the required items including a thermometer. There is a fully equipped first aid kit available in each classroom.

AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: http://mandatedreporterca.com.

Children’s Records were reviewed for completeness. Inspection of required forms were made and documented on the LIC 857. LPA reviewed Staff records, which are documented on the LIC 859. Staff present will be verified to have proof against TB, measles, pertussis, and influenza, as well as current Mandated reporter. LPA observed during staff file review, that there is at least one person present on this date and at all times, with Pediatric CPR & First Aid. Children's roster & Staff Personnel report was reviewed for completeness.

Criminal Records clearance: Licensee 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.

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. LPA referred licensee to the Department website for lead: Lead Toxicity Prevention and water Testing Information.
NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Cynthia Reyes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025
LIC809 (FAS) - (06/04)
Page: 5 of 13
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: SOUTH HILLS ACADEMY
FACILITY NUMBER: 198021431
VISIT DATE: 08/05/2025
NARRATIVE
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This facility provides incidental medical services- IMS. LPA reviewed storage of "medication and equipment, supplies, and reviewed children's personnel and 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, available at: http://www.ada.gov/resources/child-care-centers/.

Licensee was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation (within 24 hours by telephone call) and documented on the form LIC624B and submitted within 7 days by email, fax or mailed to the department. UIR Email: MPROincidentreports@dss.ca.gov

MyChildCarePlan.org – Licensee, 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.



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 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 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/process.



To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.
NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Cynthia Reyes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025
LIC809 (FAS) - (06/04)
Page: 6 of 13
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: SOUTH HILLS ACADEMY
FACILITY NUMBER: 198021431
VISIT DATE: 08/05/2025
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The department has On Duty Workers available for questions Monday through Friday at (323) 981-3350 from 8:00 AM - 5:00 PM. To access forms and regulations go online at: www.ccld.ca.gov.

Currently, the licensee is not in compliance with California Title 22 Regulations. Therefore, there was deficiency cited during today's Inspection in accordance with the California Code of Regulations Title 22, Division 12, Chapter 1. Consultation was given on this date.



***LPA will make a continuation inspection to document all citations observed on this date.*****

Exit interview conducted and report was reviewed and given to Michelle Mendoza, Teacher.
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A notice of site visit was given and must remain posted for 30 days
NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Cynthia Reyes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025
LIC809 (FAS) - (06/04)
Page: 7 of 13
Document Has Been Signed on 08/12/2025 10:06 AM - It Cannot Be Edited


Created By: Cynthia Reyes On 08/06/2025 at 10:15 AM
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: SOUTH HILLS ACADEMY
FACILITY NUMBER: 198021431

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101174(d)
Disaster and Mass Casualty Plan
(d) Disaster drills shall be conducted at least every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care.

No fire drills were documented and not conducted since 02/2025
POC Due Date: 08/22/2025
Plan of Correction
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2
3
4
Facility will conduct and document a fir and earthquake drill by the POC date and submit a copy by Email to the LPA by the POC date,
Type B
Section Cited
CCR
101239(e)(4)
Fixtures, Furniture, Equipment and Supplies
(e) Faucets used by children for personal care shall deliver hot water. (4) All toilets, handwashing and bathing facilities shall be maintained in safe and sanitary operating condition. Additional equipment, aids and/or conveniences shall be provided as needed in centers that serve children with physical disabilities.

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 which poses/posed a potential health, safety or personal rights risk to persons in care.

LPA observed 1 toilet located between class rooms 127 and 130, not flushing properly.
POC Due Date: 08/22/2025
Plan of Correction
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Facility states will have the toilet fixed and will email a copy of the fixed toilet receipt to the LPA by the POC 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.
Christina Gabelman
NAME OF LICENSING PROGRAM MANAGER:
Cynthia Reyes
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/06/2025


LIC809 (FAS) - (06/04)
Page: 8 of 13
Document Has Been Signed on 08/12/2025 10:06 AM - It Cannot Be Edited


Created By: Cynthia Reyes On 08/06/2025 at 10:15 AM
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: SOUTH HILLS ACADEMY
FACILITY NUMBER: 198021431

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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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2
3
4
Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

Staff #4,5,6,7,8, and 9 do not have a Mandated Reporter Training certificate on file.
POC Due Date: 08/22/2025
Plan of Correction
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Facility states they will have Staff #4,5,6,7,8, and 9 do the Mandated Reporter Training and subnit a copy of their certificate by the POC date.
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 which poses/posed a potential health, safety or personal rights risk to persons in care.

Staff #1,3,6,7,8 and 9 do not have proof of either or all TB, MMR, TDAP, or the FLU on file.
POC Due Date: 08/22/2025
Plan of Correction
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Facility states will email proof of Staff #1,3,6,7,8 and 9, either or all TB, MMR, TDAP, or the FLU by the POC 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.
Christina Gabelman
NAME OF LICENSING PROGRAM MANAGER:
Cynthia Reyes
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/06/2025


LIC809 (FAS) - (06/04)
Page: 9 of 13
Document Has Been Signed on 08/12/2025 10:06 AM - It Cannot Be Edited


Created By: Cynthia Reyes On 08/06/2025 at 10:15 AM
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: SOUTH HILLS ACADEMY
FACILITY NUMBER: 198021431

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101215.1(f)
Child Care Center Director Qualifications and Duties
(f) When the child care center director is absent from the center, arrangements shall be made for a fully qualified teacher as specified in Section 101216.1(c) to act as substitute. This substitute child care center director shall be aware of center operations, including total enrollment; shall be trained in program operation; and shall be designated as an authorized person to correct operational deficiencies that constitute immediate threats to children's health and safety.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on record review, the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care.
Although a teacher helped the LPA on this date as the Director has been out, there is no Designation of facility responsibility for anyone.
POC Due Date: 08/22/2025
Plan of Correction
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2
3
4
Facility states will email a copy of the Designation of facility responsibility of who will be Designated when the Director is not available, to the LPA by the POC date.
Type B
Section Cited
CCR
101215.1(m)
Child Care Center Director Qualifications and Duties
(m) A child care center director shall complete 16 hours of health and safety training if necessary pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

The Director does not have current Pediatric First Aid and CPR on file.
POC Due Date: 08/22/2025
Plan of Correction
1
2
3
4
Director will email proof of current Pediatric First Aid and CPR by the POC 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.
Christina Gabelman
NAME OF LICENSING PROGRAM MANAGER:
Cynthia Reyes
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/06/2025


LIC809 (FAS) - (06/04)
Page: 10 of 13
Document Has Been Signed on 08/12/2025 10:06 AM - It Cannot Be Edited


Created By: Cynthia Reyes On 08/06/2025 at 10:15 AM
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: SOUTH HILLS ACADEMY
FACILITY NUMBER: 198021431

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

Staff #1,3,6,7, and 9 do not have the LIC 503 Health Screening on file.
POC Due Date: 08/22/2025
Plan of Correction
1
2
3
4
Facility states will email proof of Staff #1,3,6,7, and 9 do not have the LIC 503 Health Screening by the POC date.
Type B
Section Cited
CCR
101216(l)(1)(B)
Personnel Requirements
(B) A copy of the signed LIC 9052 (11/94) shall be kept in the employee's personnel record.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

Staff #1,3,6,7, and 9 do not have the LIC 9052 on file.
POC Due Date: 08/22/2025
Plan of Correction
1
2
3
4
Facility states will email proof of Staff #1,3,6,7, and 9 LIC 9052 by the POC 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.
Christina Gabelman
NAME OF LICENSING PROGRAM MANAGER:
Cynthia Reyes
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/06/2025


LIC809 (FAS) - (06/04)
Page: 11 of 13
Document Has Been Signed on 08/12/2025 10:06 AM - It Cannot Be Edited


Created By: Cynthia Reyes On 08/06/2025 at 10:15 AM
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: SOUTH HILLS ACADEMY
FACILITY NUMBER: 198021431

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216.1(c)
Teacher Qualifications and Duties
(c) To be a fully qualified teacher, a teacher shall have one of the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

Staff #3,5,6,7, 8, and 9 do not have proof of education in file
POC Due Date: 08/22/2025
Plan of Correction
1
2
3
4
Facility states will send proof of all education requirement for each position that each staff are working in. There must be original transcripts in each staff file. Send email with proof by the POC date.
Type B
Section Cited
CCR
101217(a)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health,
safety or personal rights risk to persons in care.

Staff #2,3,6,7, and 9 do not have the LIC 501 on file.
POC Due Date: 08/22/2025
Plan of Correction
1
2
3
4
Facility will email proof of Staff #2,3,6,7, and 9 that do not have the LIC 501 on file. Email by the POC 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.
Christina Gabelman
NAME OF LICENSING PROGRAM MANAGER:
Cynthia Reyes
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/06/2025


LIC809 (FAS) - (06/04)
Page: 12 of 13
Document Has Been Signed on 08/12/2025 10:06 AM - It Cannot Be Edited


Created By: Cynthia Reyes On 08/06/2025 at 10:15 AM
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: SOUTH HILLS ACADEMY
FACILITY NUMBER: 198021431

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101217(b)(3)(A)
Personnel Records
(b) Personnel records shall be maintained for all volunteers and shall contain the following: (3) For volunteers that are required to be fingerprinted pursuant to Section 101170: (A) A signed statement regarding their criminal record history as required by Section 101170(d).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

Staff #1,3,6,7, and 9 do not have the LIC 508 on file.
POC Due Date: 08/22/2025
Plan of Correction
1
2
3
4
Facility states will Email proof of Staff #1,3,6,7, and 9 LIC 508 on file and email by the POC date.
Type B
Section Cited
CCR
101229.1(a)(1)
Sign In and Sign Out
(a) In addition to the sign-in procedure requirement of Section 101226.1(b), the licensee shall develop, maintain and implement a written procedure to sign the child in/out of the child care center that shall, at a minimum, include the following: (1) The person who signs the child in/out shall use his/her full legal signature and shall record the time of day.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review. the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

LPA observed out of 46 children 4 were not signed in and 1 other child was signed in a day early.
POC Due Date: 08/22/2025
Plan of Correction
1
2
3
4
Facility states will send a declaration on steps they will take to ensure all children are being signed in/out correctly each day and will also send a plan on how they will ensure no child is being signed in earlier then the day and time they are at school.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Christina Gabelman
NAME OF LICENSING PROGRAM MANAGER:
Cynthia Reyes
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/06/2025


LIC809 (FAS) - (06/04)
Page: 13 of 13