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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191570434
Report Date: 02/27/2024
Date Signed: 02/27/2024 02:59:38 PM


Document Has Been Signed on 02/27/2024 02:59 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:SHEPHERD OF THE VALLEY PRESCHOOL & DAY CAREFACILITY NUMBER:
191570434
ADMINISTRATOR:SOCORRO MAJANOFACILITY TYPE:
850
ADDRESS:1723 PARK LAWNTELEPHONE:
(626) 965-7076
CITY:HACIENDA HEIGHTSSTATE: CAZIP CODE:
91745
CAPACITY:74CENSUS: 16DATE:
02/27/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
12:51 PM
MET WITH:Socorro MajanoTIME COMPLETED:
03:10 PM
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Licensing Program Analyst (LPA) Jennifer Hua conducted an unannounced Random inspection. LPA met with Director Socorro Majano. A COVID-19 risk assessment was conducted prior to entry to the facility. LPA provided a copy of the LIC 125 Entrance Checklist to facilitate the inspection. This is a preschool program. Business hours are from Monday to Friday, 7:45 AM to 5:30 PM.

LPA was guided to a facility tour by Director at 1:01pm. All areas identified on the Facility Sketch were inspected. There are 4 classrooms for the preschool program: The following were observed:
  • Lusk room by office - Not in use. Per director, children will use the restroom when outside
  • Butterfly/Crayon Club room - Empty
  • Teddy Bear Room - 13 children with 1 staff
  • Classroom Rainbow - 3 children with 1 staff.

The facility was observed to be within the license capacity and limitations. Sign-In and Sign-Out sheets were reviewed.

The following were observed during the tour of the facility:
Furniture and equipment were inspected for age appropriateness and good repair, telephone service (land line in the office) and in the classrooms, heating, lighting and ventilation were evaluated. All floors were observed to be clean and safe. All materials accessible to children were observed to be toxic free. Per Director, there were no firearms stored on the premises and no pools or bodies of water. Children have their own cubby to store their belongings. Mats are hung in the closet. Blankets/sheets are sent home to be wash every Friday. Per Director, the isolation area is in the office. Age appropriate sinks and toilets were inspected for availability and good repair in all restrooms. General sanitation was observed. Availability of indoor drinking water was observed in the classroom. First Aid supplies were on top shelves in every classroom.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:
DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2024
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: SHEPHERD OF THE VALLEY PRESCHOOL & DAY CARE
FACILITY NUMBER: 191570434
VISIT DATE: 02/27/2024
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Disinfectants, cleaning solutions, and other items that are dangerous to children were inaccessible. Carbon monoxide and smoke detectors were observed in the classrooms. All kitchen areas/food preparation areas and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin.
All storage containers for solid waste, including moveable bins have tight-fitting covers that are kept on, and in good repair. Trash cans used to discard food have tight fitting lids. Per director, the facility provide snacks and lunch. Menu was observed to be posted for the month. Earthquake drill was conducted on 11/6/23 and Fire drill was conducted on 1/11/24 as observed on drill logs.

Outdoor playground equipment is in a safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. The outdoor surface is cushioned with rubber that absorbs a fall. There is adequate shade in the play yard. Per director, outdoor drinking water will be brought when children are outside. LPA advised that no children shall be left without the supervision of a teacher at any time.

All individuals present have obtained a criminal record clearance or criminal record exemption. There is at least one person trained in CPR and Pediatric First Aid present during this inspection. The review of Staff records was documented on the LIC 859.



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 Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA information Line at (800) 514-0301(voice)/ (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 Per director, children currently enrolled do not require IMS or any medication.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: SHEPHERD OF THE VALLEY PRESCHOOL & DAY CARE
FACILITY NUMBER: 191570434
VISIT DATE: 02/27/2024
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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.

Deficiencies cited on attached 809D.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Director.

SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 02/27/2024 02:59 PM - It Cannot Be Edited

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: SHEPHERD OF THE VALLEY PRESCHOOL & DAY CARE
FACILITY NUMBER: 191570434

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2024

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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3
4
Based on record review, the licensee did not comply with the section cited above in staff #1 & #2 do not have current certificate which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/08/2024
Plan of Correction
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2
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Per director, will correct and submit copy to LPA by POC due 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 in staff #3 lack measles and pertussis record in file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/08/2024
Plan of Correction
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Per director, will correct and submit copy to LPA by POC due 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.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:
DATE: 02/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5


Document Has Been Signed on 02/27/2024 02:59 PM - It Cannot Be Edited

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: SHEPHERD OF THE VALLEY PRESCHOOL & DAY CARE
FACILITY NUMBER: 191570434

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2024

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
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4
Based on record review, the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/15/2024
Plan of Correction
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Per director, will correct and submit copy to LPA by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:
DATE: 02/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2024
LIC809 (FAS) - (06/04)
Page: 5 of 5