<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191502377
Report Date: 01/08/2025
Date Signed: 01/08/2025 05:09:58 PM

Document Has Been Signed on 01/08/2025 05:09 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:CALVARY CROSS CHAPEL PRESCHOOLFACILITY NUMBER:
191502377
ADMINISTRATOR/
DIRECTOR:		ROBIN CLEMENTEFACILITY TYPE:
850
ADDRESS:16705 GRIDLEY ROADTELEPHONE:
(562) 924-3716
CITY:CERRITOSSTATE: CAZIP CODE:
90701
CAPACITY: 74TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
01/08/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:20 AM
MET WITH:Director, Robin ClementeTIME VISIT/
INSPECTION COMPLETED:
05:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPAs) Jonnisha Culbert conducted an unannounced annual/random inspection at the facility noted above. LPA met with Staff 1 (S1), discussed the purposes of the visit, and provided S1 with Entrance checklist for Child Care Centers (LIC 125). They guided analyst on a tour of the facility. This is a preschool which consists of six classrooms. Per S1, only two rooms are currently being used. The program operates from Monday through Friday from 6:30am to 5:45pm. The program offers care to children 2 to 5 years old. Present during today's inspection were 11 children with 2 staff.

At approximately 12:15pm, Director Robin Clemente arrived at the facility.

In Directors office, LPA observed all required postings. Per Director, parents use to utilize office to drop off children, but now they use side gate. LPA advised Director to post all required posting in a prominent, publicly accessible area at the facility.

All areas used by children were inspected for safety. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting, and ventilation were evaluated. The facility uses central heating and air for ventilation. Lighting was observed to be in operable condition. LPA observed age-appropriate toys. Children have their own cubby in each classroom to store their belongings. Cots are available to children for napping. Per Director, the isolation area is in the office. The two rooms that are current utilized for care have toilets and two sinks in each class available for children.

Availability of indoor and outdoor drinking water was observed in classrooms via sippy cups. Per Site Director, children bring and take home their own sippy cups daily and when they need to be refilled water is provided via water fountains located outside of classrooms. Per Director, the water was tested for lead exceedance. LPA provided Director with Provider Information Notification (PIN) 21-21.1-CCP.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE: DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/08/2025
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 10
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: CALVARY CROSS CHAPEL PRESCHOOL
FACILITY NUMBER: 191502377
VISIT DATE: 01/08/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Page 2
Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. Disinfectants and cleaning solutions are kept in cabinets above countertop in each room. Per Director, no child requires medication right now, but if they did, the medication will be kept in the child’s classroom in a cabinet above countertop or refrigerated if necessary. Poisons were not observed during visit. Per Director, there are no poison on the premises and pest control comes quarterly to spray. LPA reminded Director that if poisons are purchased, they are to remain in an area that is locked and inaccessible to children. A carbon monoxide detector was observed and is operable. LPA observed that smoke detectors was not working properly. LPA reminded Director to replace batteries. Director agreed to have maintenance replace batteries within the week. Fully charged fire extinguishers are available if needed and were last serviced on 04/24/2024.

The outdoor playground area was evaluated. LPA observed all areas around and under high climbing equipment and similar equipment are cushioned with mulch. There is adequate shade on the play yard. LPA observed plastic slide that with repaired stairs that was cracked. This poses a potential safety risk to persons in care. Per Director, the slide will be removed. Availability of outdoor drinking water was observed. Per Director, there are no pools or bodies of water at the facility.

Children’s Records were reviewed for completeness. LPA observed that 3 out 3 records were complete.

Staff records were reviewed. All staff met educational requirements. LPA observed that 3 out of 3 staff did not have a current mandated reporter certificate. This poses a potential safety risk to persons in care. LPA observed immunization records, and cardiopulmonary and resuscitation and first aid training certifications. Children's roster was reviewed and is current. Parents sign in and sign out children upon dropping off or picking them up via sign in sheet.

Disaster drills were logged and available. The last drill was conducted on 06/14/2024. LPA observed that prior to June 2024 Director performed and logged drills every month. LPA reminded director that drills are to be performed and logged every six months. Menus are available for review. Per Director, the menus are posted in each classroom. LPA inspected the food preparation area. The kitchen was observed to be clean and free of litter. LPA observed that some of the food items were expired. This poses a potential health and
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025
LIC809 (FAS) - (06/04)
Page: 4 of 10
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: CALVARY CROSS CHAPEL PRESCHOOL
FACILITY NUMBER: 191502377
VISIT DATE: 01/08/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Page 3
safety risk to persons in care. The facility provides breakfast and one afternoon snack. Per Director, parents provide lunch.
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.

Director 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 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). LPA verified that the lead testing was completed in accordance with the Written Directives outlined in PIN 21-21.1-CCP.

LPA discussed the safe sleep regulations with Director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe sleep as an additional resource. LPA also informed Director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025
LIC809 (FAS) - (06/04)
Page: 3 of 10
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: CALVARY CROSS CHAPEL PRESCHOOL
FACILITY NUMBER: 191502377
VISIT DATE: 01/08/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Page 4
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/

Director 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.

During today’s visit 3 Type B citation were cited. Please see 809D for more information.

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

Exit interview conducted and report was reviewed with the Director, Robin Clemente.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025
LIC809 (FAS) - (06/04)
Page: 2 of 10
Document Has Been Signed on 01/08/2025 05:09 PM - It Cannot Be Edited


Created By: Jonnisha Culbert On 01/08/2025 at 03:59 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: CALVARY CROSS CHAPEL PRESCHOOL
FACILITY NUMBER: 191502377

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/08/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101239(n)
Fixtures, Furniture, Equipment and Supplies
(n) Furniture and equipment shall be maintained in good condition, free of sharp, loose or pointed parts.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above and a plastic slide was cracked and not free of sharp edges, which poses a potential safety risk to persons in care.
POC Due Date: 02/03/2025
Plan of Correction
1
2
3
4
Per Director, the slide will be removed and they will send a photo showing that slice was removed to LPA J. Culbert via email by plan of correction date.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review and interview, the licensee did not comply with the section cited above in 3 out of 3 staff did not renew their mandated reporter training, which poses a potential safety risk to persons in care.
POC Due Date: 02/03/2025
Plan of Correction
1
2
3
4
Per Director, all staff will complete the training and they will email LPA J. Culbert valid mandated reporter completion certificates by plan of correction date.
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:Karen Chambers
LICENSING EVALUATOR NAME:Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:
DATE: 01/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/08/2025


LIC809 (FAS) - (06/04)
Page: 5 of 10
Document Has Been Signed on 01/08/2025 05:09 PM - It Cannot Be Edited


Created By: Jonnisha Culbert On 01/08/2025 at 03:59 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: CALVARY CROSS CHAPEL PRESCHOOL
FACILITY NUMBER: 191502377

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/08/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101227(a)(1)
Food Service
(1) All food shall be safe and of the quality and in the quantity necessary to meet the needs of the children. Each meal shall include, at a minimum, the amount of food components as specified by Title 7, Code of Federal Regulations, Part 226.20, (Revised January 1, 1990) Requirements for Meals, for the age group served. All food shall be selected, stored, prepared and served in a safe and healthful manner.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and interview, the licensee did not comply with the section cited above and LPA observed several food items that were expired or removed from original packaging and were not labeled with a date to show when they expire. This poses potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/03/2025
Plan of Correction
1
2
3
4
Per Director, they will check for expired food content monthly and log who checked and discard food. Also, they will label any food removed from original packaging with expiry dates. Director will email LPA J. Culbert a copy of log with the first food check and labels on foods removed from package by plan of correction date.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Karen Chambers
LICENSING EVALUATOR NAME:Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:
DATE: 01/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/08/2025


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