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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191598476
Report Date: 03/27/2024
Date Signed: 03/27/2024 12:35:59 PM


Document Has Been Signed on 03/27/2024 12:35 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:KELLOGG POLYTECNIC/CHILD DEVELOPMENT CENTERFACILITY NUMBER:
191598476
ADMINISTRATOR:KYM ALLENFACILITY TYPE:
850
ADDRESS:610 MEDINA ST.TELEPHONE:
(909) 397-4575
CITY:POMONASTATE: CAZIP CODE:
91768
CAPACITY:22CENSUS: 14DATE:
03/27/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Lead Naushaba NaheedTIME COMPLETED:
12:45 PM
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On 3/27/24 at 9:30am, (LPA) Licensing Program Analyst Stephanie Li and (LPM) Licensing Program Manager Claudia Guangorena conducted an unannounced annual inspection. Upon arrival licensing staff met assistant teacher Christina Morales, who led a tour of the facility. Per teacher, there are currently 14 children enrolled in the program. Hours of operation are Monday-Friday 7:30am-2:00pm. The program operates at Kellogg/Polytecnic elementary school in Rm 33. Visitors must sign in and enter through the office.

All areas identified on the Facility Sketch were inspected. The facility consists of 1 classroom and 2 outdoor play areas. The following was observed: Room 33 had 14 children and 2 staff and parent volunteer. Another preschool age classroom is on site, Rm 15 servicing special needs students ages 3-5. Teacher-child ratios were observed to be in accordance with Title 22 regulations. The Licensee is within the conditions, limitations, and capacity specified on the license. All children were observed to be under active/visual supervision of a teacher during the tour.

Licensing staff observed disinfectants, cleaning solutions, medication and other items that are dangerous to children were not accessible to children. Classroom furniture and equipment are in good condition, free of sharp, loose, or pointed parts. All floors are clean and safe. Napping equipment (mats/cots) and bedding were inspected for good condition, appropriate storage, and cleanliness. Napping linens were observed to be on children's folded mats stacked on top of each other causing direct contact with other children's linens. Touching linens is a health and safety hazard. Licensing staff advised teachers that linens need to be stored so that they are not coming into contact with other linens. Citation is being issued for nap equipment storage (see 809 D citation page) Children's linens are washed weekly by a washing service. All toilets and washing facilities are in safe and sanitary operating conditions. First Aid supplies are available and complete. Drinking water was readily available indoors. Front and back of the classroom is used as an isolation area, there is a chair available for an ill child to rest and one of the restrooms will be used if needed.

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SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Stephanie LiTELEPHONE: (626) 366-3362
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2024
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: KELLOGG POLYTECNIC/CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 191598476
VISIT DATE: 03/27/2024
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Licensing staff observed all required forms/publications to be posted by the front entrance. Snack menus were reviewed to ensure that they are being posted one week in advance where it is visible by the child's authorized representative. Menus for the past 30 days are available upon request. Facility provides breakfast and lunch through the school districts food program. All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair. Trash cans used to discard food have tight fitting lids. The facility was observed to be free of flies, other insects, and rodents.

Licensing staff observed the required 2A10BC fire extinguisher indicates fully charged and was serviced on 2/6/24 on service tag. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. Facility has a functioning carbon monoxide and smoke detector that meets statutory requirements. Teachers state there are no weapons, firearms, or bodies of water on the premises. The last Disaster drill was conducted in Jan 2024. Reminded teachers disaster drills must be conducted at least every six months.

At 10:15 am, licensing staff reviewed the outdoor play area. The playgrounds equipment is in 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. All areas around or under high climbing equipment, swings, slides, and similar equipment are cushioned with material that absorbs a fall. The children use the kindergarten playground. Licensing staff observed two damaged metal vent screens along the bottom of bungalow Rm 15. Metals vent screens are bent upwards and accessible to children posing a risk. Damaged vents need to be in good repair for the health and safety of children in care. Citation is being issued (see 809-D citation page) Drinking water is readily available outdoors.

At 10:45am, Licensing staff observed that teaching staff use the children's restroom. Teachers stated due to teacher-child ratios, they are unable to leave the classroom to use the designated staff bathroom in the staff lounge. Citation is being issued for staff bathroom. (see 809-D page) Licensing staff advised that teachers need to use the designated staff bathroom, not the children's bathroom. In the meantime, Lead teacher will contact principal to relieve her for the bathroom.

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.

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SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Stephanie LiTELEPHONE: (626) 366-3362
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024
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: KELLOGG POLYTECNIC/CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 191598476
VISIT DATE: 03/27/2024
NARRATIVE
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Staff and children records were not available for review as they are kept at the Pomona Child Devlopment Center. LPA will review records at a later date. There is at least one person trained in CPR and Pediatric First Aid present during this inspection. (Christina Morales, CPR ex. 3/2/26) Lead teacher Naushaba Neheen had proof of the AB 1207 Mandated Reporter Training certificate on file. Staff present had proof of TB.

Incidental Medical Services (IMS) is not being provided at this time. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (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

Facility 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.

To improve the quality and value of the new inspection process, a survey may 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/inspection-process.

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 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).

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SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Stephanie LiTELEPHONE: (626) 366-3362
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024
LIC809 (FAS) - (06/04)
Page: 3 of 7
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: KELLOGG POLYTECNIC/CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 191598476
VISIT DATE: 03/27/2024
NARRATIVE
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The facility has completed lead testing and is in the process of remediating lead exceedances. LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Facility was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.



Based on Licensing staff observations, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health and safety.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative.

Exit interview conducted, report was reviewed, and appeal rights were given to lead teacher Naushaba Naheen.

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SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Stephanie LiTELEPHONE: (626) 366-3362
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024
LIC809 (FAS) - (06/04)
Page: 4 of 7
Document Has Been Signed on 03/27/2024 12:35 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: KELLOGG POLYTECNIC/CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 191598476

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238(a)
Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in two metal vent screens were damaged and bent upwards, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/10/2024
Plan of Correction
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Facilities planner will contact school maintenance to replace damaged vents and send photos of replacements via email by 4/10/24
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: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Stephanie LiTELEPHONE: (626) 366-3362
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2024
LIC809 (FAS) - (06/04)
Page: 5 of 7


Document Has Been Signed on 03/27/2024 12:35 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: KELLOGG POLYTECNIC/CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 191598476

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101239.1(c)(2)
(c) Each cot or mat shall be equipped with a sheet to cover the cot or mat and, depending on the weather, a sheet and/or blanket to cover the child.
(2) Bedding shall be individually stored so that each child's bedding is identifiable and no child's used bedding comes into contact with other bedding.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above all children's cot sheets were touching eachothers, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/27/2024
Plan of Correction
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Teacher Naushaba Naheen is going to connect with campus supervisor who puts naptime bedding away to ensure that nap sheets are not touching other children's nap sheets. Lead teacher will take a photo of properly stored nap sheets and send to LPA via email by 3/27/24.
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: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Stephanie LiTELEPHONE: (626) 366-3362
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2024
LIC809 (FAS) - (06/04)
Page: 6 of 7


Document Has Been Signed on 03/27/2024 12:35 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: KELLOGG POLYTECNIC/CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 191598476

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101239(i)
(i) There shall be one toilet and one handwashing fixture, separate from and in addition to the number of toilets and handwashing fixtures required in (h) above, designated for use by children who are ill, for use by staff, and for emergency use. This toilet and handwashing fixture shall be conveniently located in relation to the isolation area.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above classroom teachers use the childrens bathroom, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/08/2024
Plan of Correction
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Lead Teacher Naushaba Naheen will pass along report and citation to child development supervsors, Mukta Cham and Peter Pinon. In the meantime, she will contact elementary school principal or assistant principle to relieve her to use the restroom when needed.
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: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Stephanie LiTELEPHONE: (626) 366-3362
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2024
LIC809 (FAS) - (06/04)
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