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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192001360
Report Date: 04/17/2025
Date Signed: 04/17/2025 01:38:04 PM

Document Has Been Signed on 04/17/2025 01:38 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:JEFFERSON STATE PRESCHOOLFACILITY NUMBER:
192001360
ADMINISTRATOR/
DIRECTOR:		MARCOS, MARIOFACILITY TYPE:
850
ADDRESS:2508 E. 133RD STREETTELEPHONE:
(310) 898-6008
CITY:COMPTONSTATE: CAZIP CODE:
90220
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 16DATE:
04/17/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Lead Teacher SanchezTIME VISIT/
INSPECTION COMPLETED:
01:50 PM
NARRATIVE
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On April 17, 2025 Licensing Program Analysts (LPAs) Portia Bowden and Christine Nolan conducted an unannounced Annual Inspection at the above facility. LPA met with Lead Teacher Ms. Sanchez, explained the reason for visit, provided LIC 125 (Entrance Checklist) and was guided on a tour. Also present during inspection was co teacher Villeda. Facility operating hours are Monday through Friday from 8 AM – 2:35PM. LPAs observed all required documents on the facility licensing board (PUB 269, PUB 393, LIC 610, LIC 9224, LIC 613A). LPAs Observed an Emergency Drill log dated 2/25.

This is a half day preschool program serving ages 2 to 5 years old, consisting of 1 classroom and an enclosed outdoor play area. Per Teacher Sanchez the AM class is held from 8-11AM and currently has 16 Children enrolled. Per Teacher Sanchez the PM Class is held from 11:35AM – 2:35PM and currently has 16 children enrolled. At 12:10PM LPAs observed 16 children in care. Also housed on the premises is a K-8th Grade Elementary School. Capacity and limitations as specified on the license are being maintained. Per Teacher Sanchez no children in care require Incidental Medical Services, while children in both the AM and PM class have food allergies (Lactose intolerant)

The following was observed during the tour of the facility: furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting, and ventilation were evaluated. At 12:25PM LPAs observed a Sense Air Carbon monoxide detector inline with the main fire system on the classroom wall. LPAs did not observe any sleeping materials as this is a half day program and no napping takes place. LPAs observed 2 age appropriate toilets, 2 age appropriate sinks and 1 changing table in good repair in the bathroom located in classroom. Per Teacher Sanchez facility provides potty.
NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Portia Bowden
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/17/2025
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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Document Has Been Signed on 04/17/2025 01:38 PM - It Cannot Be Edited


Created By: Portia Bowden On 04/17/2025 at 01:12 PM
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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: JEFFERSON STATE PRESCHOOL
FACILITY NUMBER: 192001360

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/17/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

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 that facility has not conducted required lead testing which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/01/2025
Plan of Correction
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Facility will submit proof of lead testing appointment to LPA via email
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.
Karen Chambers
NAME OF LICENSING PROGRAM MANAGER:
Portia Bowden
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/17/2025


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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: JEFFERSON STATE PRESCHOOL
FACILITY NUMBER: 192001360
VISIT DATE: 04/17/2025
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Per PIN 21-21-CCP lead testing to be conducted for all equipment used for drinking consumption. LPAs did not observe lead testing Per lead teacher Sanchez she is unaware if facility conducted testing. A Type B deficiency will be issued. Per teacher Sanchez children fill water bottles and dixie paper cups from water dispenser. Per Teacher Sanchez water cups/bottles are taken outside during outdoor play.

At 12:35PM LPA observed disinfectants stored on a high shelf in the classroom, inaccessible to children in care. Per Teacher Sanchez there are no poisons on the premises.

Facility provides breakfast and lunch which is supplied by the school cafeteria. Per Teacher Sanchez outside food is not permitted in the facility. At 12:45PM LPA observed kitchen area to be clean, free of litter, rubbish, and rodents/vermin. All food is protected from contamination. All storage containers for solid waste, including moveable bins, have tight fitting covers on and are in good repair. LPA spoke with cafeteria staff who stated kitchen knives are stored behind the counter with a supervisor, inaccessible to children in care. Per Cafeteria staff all employees have access to a list of Children with food allergies and provide substitutions. LPA observed lactose free milk option for children with food allergies



Outdoor play is conducted on a playground directly next to Preschool classrooms. Per teacher Sanchez outdoor area is shared with the Kindergarten class on a staggered schedule. At 12:50PM LPAs observed a two story play apparatus 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. There is adequate shade in the play yard. LPA advised that no children shall be left without the supervision of a teacher at any time. All floors were observed to be clean and safe. All materials accessible to children were observed to be toxic free. There are no firearms stored on the premises. There are no pools or bodies of water at the facility

LPA Reviewed no staff files as they are housed at the Compton Unified School District. LPA observed Teacher Sanchez’s current Mandated Reporter Certificate Exp 4/27 and Current Pediatric CPR/First Aid Certificate Exp 3/27 and Teacher Villeda’s Current Mandated Reporter Certificate Exp 3/27.

The name of the child care center director or fully-qualified teacher(s) designated to act in the director’s absence has been reported to the Department. The person who signs the child in/out of the facility shall use their full legal signature and record the time of day.

NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Portia Bowden
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: JEFFERSON STATE PRESCHOOL
FACILITY NUMBER: 192001360
VISIT DATE: 04/17/2025
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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.

Facility representative 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.

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.

This facility provides Incidental Medical Services – IMS. LPA did not review storage of medication as no children in care currently require it. 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 are available at: https://www.ada.gov/resources/child-care-centers/

One type B deficiency for required lead testing was observed during today’s inspection.

Exit interview conducted and report was reviewed with Teacher Sanchez, Appeal rights, and A notice of site visit were given and must remain posted for 30 days.

NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Portia Bowden
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
LIC809 (FAS) - (06/04)
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