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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021829
Report Date: 08/05/2025
Date Signed: 08/05/2025 02:44:48 PM

Document Has Been Signed on 08/05/2025 02:44 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:HLPUSD - LOS ROBLESFACILITY NUMBER:
198021829
ADMINISTRATOR/
DIRECTOR:		ABIGAIL QUERUBIN-VILLAREALFACILITY TYPE:
860
ADDRESS:1530 RIDLEY AVE.TELEPHONE:
(626) 933-6565
CITY:HACIENDA HEIGHTSSTATE: CAZIP CODE:
91745
CAPACITY: 15TOTAL ENROLLED CHILDREN: 15CENSUS: 0DATE:
08/05/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Cynthia Guerra TIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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On 8/05/2025 at 1:10 pm, Licensing Program Analyst (LPA), Crystal Green conducted an announced Pre-Licensing inspection for a Change of Location. Upon arrival, LPA met with Applicant Representative, Cynthia Guerra. The Applicant, Hacienda La Puente Unified School District, has requested to relocate the preschool program children from Palm Elementary School (198013498) located on 14740 E. Palm Ave., Hacienda Heights, CA 91745 due to the location undergoing construction. The Applicant has requested to be licensed for 15 preschool children from ages 2 to 5 years old in Classroom K1.

This facility will operate Monday to Friday and offer two sessions: AM session from 8:15am – 11:15am and PM session from 12:30pm – 3:30pm.

This facility is located on the premises of Los Robles Academy School. The entry to the preschool program will be accessible from Ridley Ave. via a side gate that leads to the K1 classroom. The gate will be kept locked during operating hours and are only unlocked when children are being dropped off and picked up. There is a TK/Kindergarten classroom located adjacent in K2 that operates separately from the preschool program.

All indoor and outdoor activity space utilized for the children was inspected today. LPA informed applicant representative that staff are required to maintain direct visual supervision of the children at all times during indoor and outdoor activities. 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 outside of classroom K1. Children will be signed in and out at the entrance to the preschool classroom.
NAME OF LICENSING PROGRAM MANAGER: Monica Cuddy
NAME OF LICENSING PROGRAM ANALYST: Crystal Green
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: HLPUSD - LOS ROBLES
FACILITY NUMBER: 198021829
VISIT DATE: 08/05/2025
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Page 2: LPA continued to tour the facility and measured all indoor and outdoor activity space. Total indoor activity space measured 958.39 square footage, which can accommodate the requested capacity. LPA observed all indoor activity space to be complete with safe, age-appropriate furniture and equipment, including tables, chairs, cubbies, bookshelves, and other activity supplies for the children. Drinking water will be available in the classrooms via filter water dispenser. 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 08/04/2025 by the Los Angeles County Fire Department.

LPA observed a total of 1 sink and 1 toilet available for children’s use. These are sufficient to accommodate the requested capacity of 15 children. There is a separate staff restroom equipped with a toilet and a sink located within the classroom. The isolation area for children who are ill will be the Nurse’s office located in the main office.

Facility will provide Breakfast for the AM session and Lunch for the PM session. Food will be prepared in the cafeteria and brought over to the facility.
The facility has a fully fenced playground area that will be shared with the TK/Kindergarten classroom. Fencing is made of chain linked which was observed to be at least four feet high. LPA obtained measurements of the outdoor yard which calculated to be 13, 122.11 square footage which can accommodate the requested capacity. This facility does not have a separate designated outdoor space for the preschool program. Per Applicant Representative, a waiver will be requested to allow the preschool program to share the outdoor space with the TK/Kindergarten classroom. A playground waiver to share the playground at different times in the AM and PM due to limited square footage shall be submitted and approved prior to licensure.

Shade is provided via a fixed canopy. There are sufficient outdoor age-appropriate toys and play equipment available on the main playground area. Drinking water is available via filter water jug. LPA observed all hazardous items on the playground to be inaccessible to children. Applicant Representative 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).
NAME OF LICENSING PROGRAM MANAGER: Monica Cuddy
NAME OF LICENSING PROGRAM ANALYST: Crystal Green
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 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: HLPUSD - LOS ROBLES
FACILITY NUMBER: 198021829
VISIT DATE: 08/05/2025
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Page 3: 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

During this inspection, LPA obtained pictures of the outdoor play area to include with the applicant’s outdoor waiver request for share space. The Applicant Representative, Cynthia Guerra, was informed that the waiver requests will be reviewed by the Regional Office for final approval.

The applicant understands that the facility may be issued a provisional license while the outdoor waiver request is under review. A provisional license will be issued for (15) preschool children from ages 2 to 5 years old in classroom K1.

Exit interview conducted and report was reviewed with the Applicant Representative, Cynthia Guerra.
NAME OF LICENSING PROGRAM MANAGER: Monica Cuddy
NAME OF LICENSING PROGRAM ANALYST: Crystal Green
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)
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