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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191802294
Report Date: 08/07/2025
Date Signed: 08/07/2025 02:48:38 PM

Document Has Been Signed on 08/07/2025 02:48 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:LUMBINI CHILD DEVELOPMENT CENTERFACILITY NUMBER:
191802294
ADMINISTRATOR/
DIRECTOR:		NICHO, LESLIEFACILITY TYPE:
850
ADDRESS:505 EAST THIRD STREETTELEPHONE:
(213) 680-2976
CITY:LOS ANGELESSTATE: CAZIP CODE:
90013
CAPACITY: 60TOTAL ENROLLED CHILDREN: 17CENSUS: 12DATE:
08/07/2025
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Leslie NichoTIME VISIT/
INSPECTION COMPLETED:
03:00 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 (LPA)s, Christine Nolan and Claudia Kam made an unannounced required visit at above licensed facility. At 10:30AM, LPA met with Leslie Nicho and was taken on a guided tour of both indoors and outdoors of the facility. LPA observed proper care and supervision and ratio. All center staff that was present during today’s inspection had fingerprint cleared and associated to this facility. At 10:45 AM, LPA observed the sign in and sign out sheets, located in the main hallway, at the entrance of the classrooms.

This preschool facilitates a kindergarten program, with children ages 2-1/2 to 5 years of age. The facility hours of operation are 7:30 am – 6:00 PM, Monday - Friday. Facility is currently licensed for a capacity of 60. At the initial start of the site visit, there is a total census of 12 children and a total census of 3 teachers present. The facility is made up of 1 large social hall, 3 classrooms, and 2 restrooms for the children. . Licensee stated, "There are currently 2 classrooms being used, due to low enrollment." At 10:55, LPA observed all posting requirements for operation on the posting board LIC 203A-License, LIC 610 A-Emergency Disaster Plan, LIC 9148-Earthquake Preparedness Check List, PUB 394-Notification of parent’s rights poster, LIC 613A- Personal Rights, PUB 269- Child Car Seat Law, Menus, and Activity Schedule. Children and staff records were reviewed. LPA discussed CPR and First Aid Certification for all center staff.

Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting, and ventilation were evaluated. Children napping equipment met the requirement regulation. The licensee stated all linen is washed once a week and returned to the facility. Storage for children's belongings, bathrooms facilities, and isolation areas were inspected. Age-appropriate sinks and toilets were inspected for availability and in good repair. Water temperature and toilet paper in both
NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Christine Nolan
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/07/2025
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 5
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)
Page: 2 of 5
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: LUMBINI CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 191802294
VISIT DATE: 08/07/2025
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
restrooms. The 2 bathrooms contained 3 toilets each and a large shared sink observed at time of inspection. LPAs observed classrooms equipped with with toys, learning supplies and art supplies, books, and other appropriate toys to be clean and free of hazards at time of inspection. LPAs observed carpets and age-appropriate tables and chairs in each classroom. LPAs observed first aid kept in classrooms.

Children drinking water was observed. The children are given individual water bottles, in addition to using their thermos. Center was reviewed for lead compliance. At 11:45 AM, LPA observed a lead testing sign, posted in the unused classroom, and a plastic bucket, covering the water spout. First Aid supplies were inventoried. At 12:00 PM, LPA reviewed the of medication policy, including administering, labeling, storage, and records. Fire & Earthquake drill observed conducted with last done 06/2025, at time of inspection. Licensee stated the facility provides an AM/PM Snack and lunch. LPA observed a monthly food menus next to the sign in book All food items are prepared on site by a volunteer. Food and snack items are properly stored. Food preparation area was toured for safety, cleanliness, and proper storage.
Carbon monoxide detectors and smoke detectors are present in the facility and were tested at time of inspection. Fire extinguishers have been serviced on 6/11/25. Hazardous items including poisonous cleaning compounds were stored inaccessible area to children.

AT 12:35, LPAs observed outdoor play area which consists of a play structure with cushioning material underneath, 3 play houses, 2 play kitchens and age appropriate tables. Outdoor equipment was inspected for safety, cushioning material, good repair, and age appropriateness. LPAs observed required shade and fencing were inspected. LPAs advised Director that the children need to be always within the direct care and

Page 2 of 4

NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Christine Nolan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025
LIC809 (FAS) - (06/04)
Page: 5 of 5
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: LUMBINI CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 191802294
VISIT DATE: 08/07/2025
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
visual supervision by the teachers. Per Director, the children have access to drinking water via water fountains, however per Director children bring personal water bottles daily. Play area was inspected for hazards and inaccessibility to bodies of water; no bodies of water or hazards observed at time of inspection.

Teacher child ratios were observed, and staff names recorded. Care and supervision evaluated to determine if the basic needs of children are met and appropriate. Sign-in and out sheets and procedures were reviewed. Personal Rights of children were observed by LPAs at time of inspection.


LPA reviewed with facility representative the LIC 311A, Records to Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted. Staff and Children’s Records were reviewed. Criminal Record Clearances were reviewed for adults. CPR card expires on 04/20/26 for Staff Member. Inspection of required forms were made.

.The following were discussed:

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, this includes any changes as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your location.

LPA advised the facility representative to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

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.

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 this regulation is violated.
NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Christine Nolan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: LUMBINI CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 191802294
VISIT DATE: 08/07/2025
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
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 child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensee pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).
LPA verified that the lead testing was completed in accordance to 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/.

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.

No deficiencies will be cited today 08/07/2025.

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



Exit interview was conducted and report was reviewed with the facility Director, Leslie Nicho.


Page 4 of 4
NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Christine Nolan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025
LIC809 (FAS) - (06/04)
Page: 4 of 5