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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191500904
Report Date: 10/10/2025
Date Signed: 10/10/2025 09:32:18 PM

Document Has Been Signed on 10/10/2025 09:32 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 DISTRICT-WOODRUFF SCHOOLFACILITY NUMBER:
191500904
ADMINISTRATOR/
DIRECTOR:		SUE CURTISFACILITY TYPE:
850
ADDRESS:15332 S. EUCALYPTUSTELEPHONE:
(562) 461-2227
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 2DATE:
10/10/2025
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Raquel Osuna, TIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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On 10/10/25 at 11:30am Licensing Program Analyst (LPA) Alicia Mooberry arrived at Woodruff Elementary School and informed office staff of reason for visit, to conducted an unannounced Required - 3 Year Inspection. School staff escorted LPA to the facility. LAP met with Lead Teacher Jasmine Hernandez and informed of reason for visit. This facility is currently licensed for capacity of 20. LPA met with Jasmine Hernandez, Lead Teacher. The program currently operates two part-time classes in the morning and afternoon. Morning class from 8:30 AM to 11:30 AM and Afternoon class is 12:30 PM to 3:30 PM. LPA observed there is a total census of 2 children and 3 staff present upon arrival. LPA toured the facility both indoors and outdoors, including adjacent playground. Raquel Ozuna, Supervisor arrived at TIME. LPA reviewed the required postings on bulletin board by classroom entrance (missing waivers for use of shared out door play yard, use of play equipment, use of elementary bathrooms, and use of Assistant for supervision.

During this visit LPA reviewed the facility lead water test results completed on 9/16/25. Results show one (1) out of three (3) drinking water source had action level exceedance of 19 PPB. (Result with values of 5.0 ppb or greater shall be deemed an Action Level Exceedance). The source is a water fountain located in the classroom that was available for drinking. Due to the water fountain was accessible to children in care, prior to testing the water, posing an immediate risk to the children in care. An A deficiency is cited during this visit. LPA observed that the water fountain has been covered with plastic wrap while awaiting repair or removal, making it inaccessible to children in care.

LPA observed individual water bottles for children's use, and water dispenser on the play ground area (tested and found lead not detected (ND). All food items were prepared in school kitchen and delivered daily to the facility ready to serve.


----Page 1 - Report Continues
NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Alicia Mooberry
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 6
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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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: BELLFLOWER UNIFIED SCHOOL DISTRICT-WOODRUFF SCHOOL
FACILITY NUMBER: 191500904
VISIT DATE: 10/10/2025
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The facility is made up of single separate bungalow next to Kindergarten classrooms. LPA observed furniture, equipment, toys and material are age appropriate and in good repair, free of loose and sharp parts. Telephone service, heating, lighting and ventilation were evaluated. There were cubbies observed as storage for children's belongings. There is no napping equipment at the facility due to part time programs and no naps are scheduled. LPA observed individual water bottles labeled with child names available for children in care. Children bring their own water bottle from home and may refill from water station in play area. Age appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, area safety and sanitation.
Snack/lunch menus were reviewed. Per Staff, facility serves AM Snack and PM snack and food is delivered from school cafeteria. During this visit, LPA observed that A first aid kit is kept in a backpack hanging by the entrance and was inventoried for supplies. Medications (if needed) stored in first aid backpack, inaccessible to children in care. Carbon monoxide and smoke detectors are present in the facility. Fire extinguishers were last serviced on 07/30/2025.

The utdoor equipment was inspected for safety, cushioning material, good repair and age-appropriateness. Facility shares outdoor play yard with Kindergarten class, LPA did not observed waiver on file during inspection. LPA observed daily schedule indicating outdoor play times for AM and PM. LPA observed swing set with four seats, and a large play structure with slide, climbing aparatus and wall with foam floor under to absorb fall all well maintained. Required shade and fencing were inspected. LPA observed staff provide supervision during outdoor playtime. Play area was inspected for hazards and inaccessibility to bodies of water; no bodies of water or hazards observed.

Teacher-child ratios were observed and staff names recorded. Care and supervision was evaluated to determine if the basic needs of children are met and appropriate.
Sign-in and out sheets and procedures were reviewed. LPA observed all children present in the AM program have been signed in and out all children present for PM program signed in with full legal signatures. Personal Rights of children were observed by LPA.

----Page 2 Report Continues

NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Alicia Mooberry
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2025
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: BELLFLOWER UNIFIED SCHOOL DISTRICT-WOODRUFF SCHOOL
FACILITY NUMBER: 191500904
VISIT DATE: 10/10/2025
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Confidential files for children and staff are kept in ECE Office and not available for review at facility. As a condition of employment for Bellflower Unified School District, all staff have been fingerprint cleared. CPR card expires on 10/9/2027 for S1 and S2. LPA observed AB1207 completed on 09/22/25 for S1. LPA discussed requirement of AB1207 training for all staff with ECE Supervisor.

Disaster and fire drill log was posted and last drill was conducted on 09/23/25

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.

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/

Facility representative was reminded that all adults 18 and over in the facility, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed facility. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA advised of the requirement to report Unusual Incidents and/or injuries to the parent/guardian and to CCL within the time frame specified by the regulation.

Facility representative 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.

-Page 3 Report Continues

NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Alicia Mooberry
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2025
LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 10/10/2025 09:32 PM - It Cannot Be Edited


Created By: Alicia Mooberry On 10/10/2025 at 01:37 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 DISTRICT-WOODRUFF SCHOOL
FACILITY NUMBER: 191500904

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/10/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Type A
Section Cited
CCR
101700.3(b)(1)-(b)
Result with values of 5.0 ppb or greater shall be deemed an Action Level Exceedance. This requirement was not met as evidence by record review. Lead test results showed that one water source had an action level exceedance.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in 1 of 3 water sources used for drinking water resulted in value greater than 5.0 ppb which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/10/2025
Plan of Correction
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During facility visit, observed children have filtered water readily avilable. LPA took photos of faucet with lead exceedance that has been covered and made inaccessible, collected the plan of correction (POC) to permanently disabled the water faucet and water fountain sources. Per ECE Supervisor they will submit pictures and documentation showing the water fountain repaired or removed via email by 10/30/25.
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: 10/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/10/2025


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: BELLFLOWER UNIFIED SCHOOL DISTRICT-WOODRUFF SCHOOL
FACILITY NUMBER: 191500904
VISIT DATE: 10/10/2025
NARRATIVE
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LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

One A deficiency was cited in accordance with Title 22 regulations (see attached LIC 809D).

A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit. A copy of the Parent Notification Requirements was also provided to the licensee.

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: 10/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2025
LIC809 (FAS) - (06/04)
Page: 6 of 6