197416900-6-17-2026-54-CC-CKAM-DV5PDU-20260617111406

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197416900
Report Date: 06/17/2026
Date Signed: 06/17/2026 11:14:40 AM

Document Has Been Signed on 06/17/2026 11:14 AM - 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:	107TH. STREET ELEMENTARY SCHOOL CSPP/HEAD START		FACILITY NUMBER:	197416900
ADMINISTRATOR/ DIRECTOR:	ALETA WILLIAMS		FACILITY TYPE:	850
ADDRESS:	146 EAST 107TH. STREET ROOM K4		TELEPHONE:	(323) 756-8137
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90003
CAPACITY: 22	TOTAL ENROLLED CHILDREN: 16	CENSUS: 0	DATE:	06/17/2026
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Sandra Wilson		TIME VISIT/ INSPECTION COMPLETED:	12:00 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	On 6/17/2026 at 9:00 AM an unannounced Required – 3 Year Inspection was conducted by Licensing Program Analyst (LPA) Claudia Kam. LPA announced purpose of visit and met with Facility Representative, Assistant Principle Sandra Wilson. Facility is currently licensed for a capacity of 22. The program currently operates Monday - Friday from 8:00 am to 2:23 pm., Tuesday 8:00 am to 1:23 pm. LPA was taken on a guided tour of the facility of both indoors and outdoors. Required postings were observed. Entrance Checklist LIC 125 was provided. The facility is made up of 1 classroom. At the initial start of the site visit, there is a total census of 0 children and a total census of 0 teachers and 1 aide present. No children were in attendance as school has ended for the 2025-2026 school year on 6/10/2026. Furniture and equipment were inspected for age appropriateness and good repair. LPA observed surface of classrooms to be safe and clean, and child size tables and chairs available for children with rounded edges and well maintained. LPA observed learning stations for dramatic play, math, and science with a variety of age appropriate toys maintained free of loose and sharp parts and a library area available for quiet play. Telephone service, heating, lighting and ventilation were evaluated. There were cubbies observed as storage for children's belongings. Mats were inspected and found to meet regulation. Per Staff the mats are cleaned weekly and linens placed on the mat. Mats are labeled for each child and stored with plastic to prevent contamination. Per FR linens are provided by the facility and washed by weekly laundry service. Availability of drinking water was reviewed. Per staff children bring in their personal water bottles and there are disposable water bottles available. Page 1 of 4

NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Claudia Kam
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/17/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2026

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 12

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 12

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: 107TH. STREET ELEMENTARY SCHOOL CSPP/HEAD START	FACILITY NUMBER: 197416900
	VISIT DATE: 06/17/2026

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

Children may refill their bottle at the outside water dispenser. The bubbler in the classroom is shut off. Age appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, area safety and sanitation. LPA observed bathroom available in the classroom that had two toilets and two sinks. The bathroom is shared and a waiver is posted for the shared bathroom. Hazardous items including poisonous cleaning compounds were stored inaccessible to children. Per FR, only LAUSD approved disinfectants are present at the facility and are stored in the maintenance closet.

A first aid kit is kept in the closet of the classroom. LPA was unable to test the carbon monoxide detector. Per facility representative they are unsure if the carbon monoxide is hardwired to the smoke detector located in the classroom. LPA observed smoke detectors and fire extinguishers are present in the facility. Disaster drill log reflects last drill conducted on 6/1/2026. Isolation area for sick children is in the nurses office where LPA observed child will have full supervision until child is picked up by Authorized Representative. Per FR, they currently have 0 children that require medication. Per facility representative medication would be stored if needed in the nurses office which is centrally located but inaccessible to children.

Snack/lunch menus were not posted at the time of inspection as the classroom has been cleaned for the new school year. Facility provides Breakfast and Lunch. Food is prepared by the school and delivered daily to the classroom. Trash cans used to discard food have tight fitting lids and solid waste bags. Food is discarded immediately after each meal.

Outdoor equipment was inspected for safety, cushioning material, good repair and age-appropriateness. LPA observed surface of outdoor play areas to be safe and maintained for activities planned. LPA observed a variety of age appropriate toys available, a play structure with 2 slides, music area, tunnel, table and benches for activities and a bike path. Required shade and fencing were inspected and large shade trees and awning were observed. LPA advised facility representative that the children need to be within the direct care and supervision, including visual supervision of the teacher at all times. The children have access to drinking fountains during outside play in addition to their personal water bottles. Play area was inspected for hazards and inaccessibility to bodies of water; no bodies of water or hazards observed.

Page 2 of 4

NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Claudia Kam
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/17/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2026

LIC809 (FAS) - (06/04)

Page: 3 of 12

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: 107TH. STREET ELEMENTARY SCHOOL CSPP/HEAD START	FACILITY NUMBER: 197416900
	VISIT DATE: 06/17/2026

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

Sign-in and out sheets and procedures were reviewed. Staff and children’s records were reviewed for completeness. Inspection of required forms was made and documented on the LIC 857 for children and the LIC 859 for staff. LPA did not review confidential staff files during the inspection due to the staff confidential files being stored at the administrative office. CPR card expires on 8/2026 for staff. 1 of 3 staff files were not present for review. Staff present did not have proof of the AB 1207 Mandated Reporter Training certificate on file. All staff and employees have obtained a criminal record clearance or criminal record exemption as a condition of employment with the Los Angeles Unified School District (LAUSD).

The following were discussed:
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, 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 child care 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 to the Written Directives outlined in PIN 21-21.1-CCP.

Page 3 of 4

NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Claudia Kam
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/17/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2026

LIC809 (FAS) - (06/04)

Page: 4 of 12

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: 107TH. STREET ELEMENTARY SCHOOL CSPP/HEAD START	FACILITY NUMBER: 197416900
	VISIT DATE: 06/17/2026

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

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.

Based on this information the following deficiencies on the LIC 809 D are being cited today 6/17/2026.

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

Exit interview conducted and report was reviewed with the Facility Representative, Assistant Principle Sandra Wilson.

Page 4 of 4

NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Claudia Kam
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/17/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2026

LIC809 (FAS) - (06/04)

Page: 5 of 12

Document Has Been Signed on 06/17/2026 11:14 AM - It Cannot Be Edited

Created By: Claudia Kam On 06/17/2026 at 10:55 AM

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: 107TH. STREET ELEMENTARY SCHOOL CSPP/HEAD START	FACILITY NUMBER: 197416900
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/17/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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 file review, the licensee did not comply with the section cited above 3 of 3 staff do not have current mandated reporter which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/15/2026
	Plan of Correction
1 2 3 4	Facility representative will have all staff complete the mandated reporter by 9/15/2026 and submit verification to Licensing.

Type B

Section Cited

CCR

101217(d)

Personnel Records

(d) All personnel records shall be maintained at the child care center and shall be available to the licensing agency for review. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on recod review, the licensee did not comply with the section cited above 1 of 3 staff did not have a file for review which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/15/2026
	Plan of Correction
1 2 3 4	Faciity represnative will complete all docs and submit file for review to Licensing by 9/15/2026

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Denise Gibbs
NAME OF LICENSING PROGRAM MANAGER:

	Claudia Kam
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/17/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2026

LIC809 (FAS) - (06/04)

Page: 6 of 12