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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015507
Report Date: 01/15/2025
Date Signed: 01/15/2025 04:00:57 PM

Document Has Been Signed on 01/15/2025 04:00 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:MOTHER OF SORROWS PRESCHOOLFACILITY NUMBER:
198015507
ADMINISTRATOR:ALEJANDRA FRUTOSFACILITY TYPE:
850
ADDRESS:8803 S. MAIN STREETTELEPHONE:
(323) 750-3700
CITY:LOS ANGELESSTATE: CAZIP CODE:
90003
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 15DATE:
01/15/2025
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:TIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Franchesca White arrived at the above facility for the purpose of an unannounced 3 year annual. LPA White announced the purpose of the visit and was granted entry into the facility by Karla Arvizu, Principal. LPA White was escorted to the Preschool campus across the street from the Elementary campus. Upon entry of the facility LPA White observed 15 children and two staff (Lead Teacher and a Teacher's Assistant). All staff have current criminal background clearance. LPA White observed the parent board to have the facility License, Personal Rights, Parent's Rights, Acknowledgement of Receipt of Licensing Reports, and the Emergency Disaster Plan. The disaster drill log was not available at the time of inspection. Lead Teacher states that drills are conducted every three months.

LPA White observed the children gathered on a large multi-colored area carpet where the children were seated in individual squares receiving instructions from the Teacher's assistant. LPA White observed the classroom to have cubbies for the children's individual belongings. Along the walls there are storage shelves with age-appropriate toys and activities neatly stored. LPA White observed the daily schedule board to have all the morning activities posted for the children to see.
There is a smaller area rug in the center of the room with two kidney bean tables on each side making a total of four tables. LPA White observed the counter of the kitchen space to have the children's water cups with sealed tops. Lead Teacher states that the children bring there own water cups, and they refill them as needed during the day. LPA White observed the water to be stored in the refrigerator. LPA White observed a case of Arrowhead drinking water bottles. Lead Teacher states that meals are not prepared at the school. They have food delivery through the Archdiocese. Children bring there own snacks.

LPA White observed the children's restrooms to be clean with soap, toilet paper and paper towels for the children. Both restrooms had extra supplies available in each stall. The bathrooms have one toilet and one hand washing station in each.
.................................................................Report Continues 1 of 3 Pages..................................................
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Franchesca White
LICENSING EVALUATOR SIGNATURE: DATE: 12/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/15/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: MOTHER OF SORROWS PRESCHOOL
FACILITY NUMBER: 198015507
VISIT DATE: 01/15/2025
NARRATIVE
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LPA White observed cleaning agents to be stored separately from food supplies in a locked cabinet inaccessible from children in care. Items are stored in the locked cabinets above the cubbie space for children. The facility indoor space was observed to be clean, and safe with equipment in good repair.

LPA White observed the outdoor play area to be fenced with a tarp covering the gate to protect the privacy of the children. in with ample shade for the children in care. There is a large play structure with a slide, bar and rock climbing. LPA White observed play structure to be in good repair, with cushioning on the floor that would absorb a fall. LPA observed a dramatic play area to have a kitchen setup, tables with chairs, with an area rug for children to play in the shade. LPA observed an off limits area containing the electrical box and air conditioning 'it to be made inaccessible to children in care with a 5ft fence with a lock. LPA observed another off limits area to have storage items and equipment behind the facility made inaccessible to children in care with an iron 5ft gate with a lock.

LPA White observed the children's files and did not see LIC 613A, 9224, 700, 701, 995, 627 in any of the children's files . All files had an admission's agreement and current immunization files. LPA White observed the staff files and did not observe the files to have the following documentation: Proof of immunization, TB Clearance, LIC 503, 508,9108,9052. Staff #1 had mandated reporter training with an expiration date of 12/24/2026. CPR certificate was not available at the time of inspection. Staff #2 - CPR: 12/6/2026, Mandated Reporter Training: 12/23/2026.
At 12:45 p.m., LPA White observed the carbon monoxide, and smoke detector to be operable at the time of inspection. Fire extinguisher was observed to have a service tag date May 21, 2024.

The following items were discussed:
LPA White offered Technical Support Program (TSP) to assist the facility in coming into compliance. Facility Representative, La Teyre Bean and Angelica Ponce agreed to participate in TSP. LPA White will move forward with the referral for TSP.

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.
......................................................Report Continues 2 of 3 Pages..........................................................
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Franchesca White
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2025
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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: MOTHER OF SORROWS PRESCHOOL
FACILITY NUMBER: 198015507
VISIT DATE: 01/15/2025
NARRATIVE
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Facility Representative, La Teyre Bean and Angelica Ponce 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.

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 are available at: https://www.ada.gov/resources/child-care-centers/. PIN 22-05-CCP Page Five

Facility Representative, La Teyre Bean and Angelica Ponce 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.

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

The following deficiencies are being cited on LIC 809-D page in accordance with Title 22 Regulations.

Exit interview conducted and report was reviewed with the licensee facility representative, La Teyere Bean, and Angelica Ponce. PIN 22-05-CCP Page Six.

A copy of the report, and appeal rights was given to facility representative, La Teyere Bean and Angelica Ponce.

................................................................Report Ends Here 3 of 3 Pages..............................................
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Franchesca White
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2025
LIC809 (FAS) - (06/04)
Page: 9 of 9
Document Has Been Signed on 01/15/2025 04:00 PM - It Cannot Be Edited


Created By: Franchesca White On 01/15/2025 at 02:51 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: MOTHER OF SORROWS PRESCHOOL
FACILITY NUMBER: 198015507

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/15/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101174(d)(2)
Disaster and Mass Casualty Plan
(d) Disaster drills shall be conducted at least every six months. (2) The drills shall be documented. This documentation shall be kept in the child care center for at least one year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, record review, the licensee did not comply with the section cited above. Facility did not have current disaster drill log available at the time of inspection which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/17/2025
Plan of Correction
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Licensee states that a copy of the updated disaster drill log will be emailed to LPA White on or before 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 inStaff did not have proof of immunization 2 out of 2 files which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/17/2025
Plan of Correction
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Licensee states that all files will have required documentation on or before the POC date of 2/17/2025
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:Denise Gibbs
LICENSING EVALUATOR NAME:Franchesca White
LICENSING EVALUATOR SIGNATURE:
DATE: 01/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/15/2025


LIC809 (FAS) - (06/04)
Page: 2 of 9
Document Has Been Signed on 01/15/2025 04:00 PM - It Cannot Be Edited


Created By: Franchesca White On 01/15/2025 at 02:51 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: MOTHER OF SORROWS PRESCHOOL
FACILITY NUMBER: 198015507

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/15/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101215.1(b)
Child Care Center Director Qualifications and Duties
(b) All child care centers shall have a director.

This requirement is not met as evidenced by:
Deficient Practice Statement
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3
4
Based on observation, interview, record review, the licensee did not comply with the section cited above. Facility has not hired a director with required qualifications which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/17/2025
Plan of Correction
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Licensee states that director will be hired on or before the POC date of 2/17/2025.
Type B
Section Cited
CCR
101217(a)(12)
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: (12) Tuberculosis test documents as specified in Section 101216(g).

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 instaff did not have proof of tb on file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/17/2025
Plan of Correction
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Licensee states that all files will have required tb testing in file on or before the POC date of 2/17/2025.
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:Denise Gibbs
LICENSING EVALUATOR NAME:Franchesca White
LICENSING EVALUATOR SIGNATURE:
DATE: 01/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/15/2025


LIC809 (FAS) - (06/04)
Page: 3 of 9
Document Has Been Signed on 01/15/2025 04:00 PM - It Cannot Be Edited


Created By: Franchesca White On 01/15/2025 at 02:51 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: MOTHER OF SORROWS PRESCHOOL
FACILITY NUMBER: 198015507

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/15/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101221(b)(8)(C)
Child's Records
(C) A signed consent form for emergency medical treatment unless the child's authorized
representative has signed the statement specified in Section 101220(f).

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 children's files did not have signed consent for emergency treatment which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/17/2025
Plan of Correction
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Licensee states that children's files will have all department required documents on or before the POC date of 2/17/2025.
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:Denise Gibbs
LICENSING EVALUATOR NAME:Franchesca White
LICENSING EVALUATOR SIGNATURE:
DATE: 01/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/15/2025


LIC809 (FAS) - (06/04)
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