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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191601006
Report Date: 04/16/2025
Date Signed: 04/16/2025 04:15:38 PM

Document Has Been Signed on 04/16/2025 04:15 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:M A W CHILDREN'S CTRFACILITY NUMBER:
191601006
ADMINISTRATOR/
DIRECTOR:		SHELIA PALMERFACILITY TYPE:
850
ADDRESS:5510 CLARK AVETELEPHONE:
(562) 867-4083
CITY:LAKEWOODSTATE: CAZIP CODE:
90712
CAPACITY: 56TOTAL ENROLLED CHILDREN: 56CENSUS: 23DATE:
04/16/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:40 PM
MET WITH:Director, Sheila PalmerTIME VISIT/
INSPECTION COMPLETED:
04:20 PM
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On 04/16/2025 at 12:40pm, Licensing Program Analysts (LPA) Jonnisha Culbert conducted an unannounced case management continuation inspection at the facility noted above. LPA met with Director, Sheila Palmer and discussed the purposes of the visit. The purpose today's visit is to continue an annual/random inspection that was original performed on 03/19/2025. Director guided analysts on a tour of the facility. This is a preschool located inside of a Community Care Center. The space consists of one large room that is divided by two sliding wall panels, which are used to create three separate classrooms. The program operates Monday through Friday from 6:45am to 5:30pm, and it offers care to children 2 to 5 years old. Present during today's inspection were Director, 5 staff, and 23 children.

Please note that the information in this report was gathered on two separate days. The annual/random inspection tour and partial file review was conducted on 03/19/2025 and on 04/16/2025 LPA completed the file review and wrote the report.

Upon arrival, LPA reviewed facility require postings and observed that earthquake preparedness was missing. LPA reminded Director to add form to bulletin.

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 lounge. Children who are

NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Jonnisha Culbert
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/16/2025
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.

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Document Has Been Signed on 04/16/2025 04:15 PM - It Cannot Be Edited


Created By: Jonnisha Culbert On 04/16/2025 at 02:53 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: M A W CHILDREN'S CTR
FACILITY NUMBER: 191601006

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/16/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238(a)
Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above and the unlocked playground door alarm was not working. LPA observed that when opened, the door leads to the street and it is also adjacent to a fenced electrical box. This poses a potential safety risk to persons in care.
POC Due Date: 04/16/2025
Plan of Correction
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Per Director, the alarm for the for door will be fixed by plan of correction 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 revview, the licensee did not comply with the section cited above in 2 out of 6 staff were not immunized against pertussis which poses a potential health and safety risk to persons in care.
POC Due Date: 05/16/2025
Plan of Correction
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Per Director, staff made appointments and will be immunized against pertussis. Director will email LPA J. Culbert proof that of both individuals are immunized against pertusiss by plan of correcttion 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.
Karen Chambers
NAME OF LICENSING PROGRAM MANAGER:
Jonnisha Culbert
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/16/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/16/2025 04:15 PM - It Cannot Be Edited


Created By: Jonnisha Culbert On 04/16/2025 at 02:53 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: M A W CHILDREN'S CTR
FACILITY NUMBER: 191601006

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/16/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record revview, the licensee did not comply with the section cited above in 1 out of 6 staff physical health was not verified by a health screening. 1 out of 6 was missing a test for tuberculosis on the screening which poses a potential health and safety risk to persons in care.
POC Due Date: 05/16/2025
Plan of Correction
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Per Director, both staff will have the screening performed and documented. Documetation of the screening with tuberculosis test will be t to emailed LPA J. Culbert by plan of correction date.
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:
Jonnisha Culbert
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/16/2025


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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: M A W CHILDREN'S CTR
FACILITY NUMBER: 191601006
VISIT DATE: 04/16/2025
NARRATIVE
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sick utilize staff restroom if needed. LPA observed six toilets and four sinks available for children. One of the toilets has caution tape on it. Per Director, the toilet stopped working today and I will be fixed today.

Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible. Disinfectants and cleaning solutions were placed on high shelves inside of cabinets. LPA reminded Director that if any one child can reach cleaning solutions, then it is no longer inaccessible. Per Director, they store medication at the facility. LPA observed that medications are kept in kitchen cabinet above counter. LPA reminded Director of Incidental Medical Services (IMS) requirements. Poisons were not observed during visit. Per Director, there are no poison on the premises. 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 fire alarm pull station near the entrance of the facility.



Availability of indoor and outdoor drinking water was observed via water fountain inside of classroom and outside on the playground. Per Director, staff assist children with filling their sippy cups at the fountains. LPA verified that the lead testing was completed in accordance with written directive outlined in Provider Information Notification (PIN) 21-21.1-CCP.

The outdoor playground area was evaluated. LPA observed all areas around and under high climbing equipment and similar equipment are cushioned with sand. Per Director, the sand is cleaned, in the mornings, daily by the city. LPA observed no debris present in the sand. Shade sails provide adequate shade on the playground. LPA observed an empty wade pool. LPA reminded Director that water must be discarded after each use. Per Director, there are no pools or bodies of water at the facility.

On the playground, LPA observed two doors providing access to the exterior of the facility. Both doors are equipped with push bars that opens the door when the bar is pressed and pushed. LPA opened both doors. LPA observed that one door provides access to a parking lot, while the other leads to the street (Clark). The door leading to the street is adjacent to a gate displaying a high voltage warning sign. LPA observed an alarm designed to signal when the door is opened. However, during the time of inspection, the alarm was not functioning. This poses potential safety risk to persons in care. LPA recommended fixing door alarm to ensure alarm sounds when the door is opened.
NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Jonnisha Culbert
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2025
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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: M A W CHILDREN'S CTR
FACILITY NUMBER: 191601006
VISIT DATE: 04/16/2025
NARRATIVE
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Disaster drills were logged and available. The last drill was conducted on 10/16/2024. Menus are posted one month in advance where it is visible by the child's authorized representative. Menus for the past 30 days are available upon request. LPA inspected the food preparation area. The kitchen was observed to be clean and free of litter. Food supplies were observed to be in good condition. The facility provides two snacks, breakfast, and lunch.

Children’s Records were reviewed for completeness. During record review LPA observed that 2 out of 2 records were complete. Children's roster was reviewed and is current. Parents sign children in and sign out using full legal name. LPA reviewed signatures on sign and out sheet.

Staff records were reviewed. During staff record review, LPA observed that 2 out 6 staff were missing immunization against pertussis. This is a potential health and safety risk to persons in care. 1 out of 6 staff was missing Health History Report form (LIC 503). This is a potential health and safety risk to persons in care. All staff had mandated reporter certificates.

During record review, it was observed that the facility fees are past due. LPA recommended the outstanding payment is promptly paid to prevent potential closure.

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.

NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Jonnisha Culbert
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2025
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: M A W CHILDREN'S CTR
FACILITY NUMBER: 191601006
VISIT DATE: 04/16/2025
NARRATIVE
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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.

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/

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.

Three type B deficiencies were cited during today’s visit. Appeal rights were given.

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

Exit interview conducted and report was reviewed with the Director, Sheila Palmer.

NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Jonnisha Culbert
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2025
LIC809 (FAS) - (06/04)
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