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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191500902
Report Date: 10/15/2025
Date Signed: 10/15/2025 07:53:21 PM

Document Has Been Signed on 10/15/2025 07:53 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:BELLFLOWER UNIFIED SCHOOL DIST.-LAS FLORES SCHOOLFACILITY NUMBER:
191500902
ADMINISTRATOR/
DIRECTOR:		JANAN HUGHESFACILITY TYPE:
850
ADDRESS:10039 E. PALM STREETTELEPHONE:
(562) 461-2227
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 8DATE:
10/15/2025
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Raquel Osuna, ECE SupervisorTIME VISIT/
INSPECTION COMPLETED:
03:55 PM
NARRATIVE
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On 10/15/25, at 2:15pm, Licensing Program Analyst (LPA) Alicia Mooberry conducted an unannounced Case Management inspection to address Lead testing results in exceedance of recommended safe levels for water consumption. LPA met with Raquel Osuna, Facility Representative. There were 3 staff supervising 8 children.

The purpose of today's inspection was to go over the water lead test results received on 9/16/25. Results show that 1 out of 4 water sources tested had action level exceedance of lead. The water fountain located in the kitchen/food prep area (Label C), had lead exceedance result of 18 ppb (Result with values of 5.0 ppb or greater shall be deemed an Action Level Exceedance). LPA observed that the kitchen/prep area to be barricaded by a wooden book shelf on one end and a half door on the other. This poses a potential risk to the health and safety of children in care. Per Facility Representative, children bring water bottles filled with water from home and if needed they refill their bottle with water from water fountains outside. LPA observed that the water faucet (lable C) water has been turned off). Per facility representative the water faucet (label C) will be removed as a plan of correction.

LPA observed individual water bottles for children's use, and water fountain on the play ground area tested and lead level 1 or Not Detected. All food items were prepared in school kitchen and delivered daily to the facility ready to serve.

One B deficiency was cited in accordance with Title 22 and Health and Safety regulations (see attached LIC 809D).

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

Exit interview was conducted and report was reviewed with the Facility Representative, Raquel Osuna.

NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Alicia Mooberry
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2025
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 10/15/2025 07:53 PM - It Cannot Be Edited


Created By: Alicia Mooberry On 10/15/2025 at 03:21 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: BELLFLOWER UNIFIED SCHOOL DIST.-LAS FLORES SCHOOL
FACILITY NUMBER: 191500902

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/15/2025
Section Cited
CCR
101700.3(b)(1)-(b)

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Result with values of 5.0 ppb or greater shall be deemed an Action Level Exceedance.

This requirement is not met as evidence by:
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The deficiency was corrected during this facility visit, LPA observed children have filtered water readily available. LPA observed faucet with lead exceedance to be barricaded and inaccessible to children, LPA collected the plan of correction (POC) to remove water faucet from classroom.
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Based on observation and record review, the licensee did not comply with the section cited above in that 1 out of 4 water sources resulted in value greater than 5.0 ppb which poses a potential risk to the health, safety or personal rights risk to persons in care
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Per ECE Supervisor they will submit pictures and documentation showing the water fountain repaired or removed via email by 10/30/25.

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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.
Warren Birks
NAME OF LICENSING PROGRAM MANAGER:
Alicia Mooberry
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/15/2025


LIC809 (FAS) - (06/04)
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