197416902-6-2-2026-54-CC-CKAM-DUNTW9-20260602150511

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197416902
Report Date: 06/02/2026
Date Signed: 06/02/2026 03:05:46 PM

Document Has Been Signed on 06/02/2026 03:05 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:	99TH STREET ELEMENTARY SCHOOL CSPP/HEAD START		FACILITY NUMBER:	197416902
ADMINISTRATOR/ DIRECTOR:	MARISSA BORDON		FACILITY TYPE:	850
ADDRESS:	9900 S.WADSWORTH AVE.RMS 12,13		TELEPHONE:	(323) 564-2677
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90002
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 16	CENSUS: 15	DATE:	06/02/2026
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:45 AM
MET WITH:	Marissa Bordon		TIME VISIT/ INSPECTION COMPLETED:	03:45 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 6/2/2026 at 11:45 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 (FR) Teacher Ms. Garner. Facility is currently licensed for a capacity of 24. The program currently operates Monday - Friday from 8:00 am to 2:23 pm., Tuesday 8:00 am - 1:23p. LPA was taken on a guided tour of the facility of both indoors and outdoors. Required postings were observed. Postings discussed for visibility at drop off and pick up. Entrance Checklist LIC 125 was provided. The facility is made up of 1 classroom (Room 33). At the initial start of the site visit, there is a total census of 15 children and a total census of 1 teacher and 1 aide present. Furniture and equipment were inspected for age appropriateness and good repair. LPA observed surface of classrooms to be safe and clean, with child size tables and chairs available for children with rounded edges and well maintained. Additional tables and chairs recommended for smaller children as the current tables and chairs are for preschool ages 4-5 years old, current license is for ages 2-5 years old. 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. Currently children are sharing cubbies with 2 hooks in each. Cots were inspected and found to meet regulation. Linens are individually stored in a black bag for each child and each cot is labeled. Per FR linens are provided by the facility and washed by weekly laundry service. Availability of drinking water was reviewed. LPA observed pint size disposable water bottles labeled for each child. The bubbler in the classroom has been shut off. Per FR they have extra water bottles for children. Age appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, area safety and sanitation. Page 1 of 4

NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Claudia Kam
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2026

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 14

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 14

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: 99TH STREET ELEMENTARY SCHOOL CSPP/HEAD START	FACILITY NUMBER: 197416902
	VISIT DATE: 06/02/2026

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

LPA observed bathroom available in classroom that had 1 toilet and 1 sink. There is a waiver on file for usage of the elementary bathroom. Waiver was not observed posted. LPA provided waiver to FR. Hazardous items including poisonous cleaning compounds were stored inaccessible to children. Per FR, only LAUSD approved disinfectants are present at the facility, LPA observed these items stored on high shelves out of reach of children at time of inspection.

A first aid kit is kept in the classroom closet. LPA was unable to confirm if carbon monoxide is hardwired. No carbon monoxide detector observed. LPA observed smoke detectors and fire extinguishers are present in the facility. Disaster drill log reflects last drill conducted on 5/6/2026. 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 no children that require medication. LPA observed medication if needed will be stored in the nurses office which is centrally located but inaccessible to children.

Snack/lunch menus were reviewed and observed posted. Facility provides Breakfast, Lunch. Food and snacks were reviewed for availability, quantity and appropriateness to children in care. Food preparation areas was toured for safety, cleanliness and proper equipment. Food is prepared in the elementary school kitchen and delivered daily to the classroom. Trash cans used to discard food has a solid waste bag with a loose fitting lid. Food is not discarded till the end of the day. The need to discard food immediately or obtain a trash can with a tight fitting lid was discussed.

Outdoor equipment was inspected for safety, cushioning material, good repair and age-appropriateness. LPA observed surface of outdoor play areas to be unsafe and not maintained for activities planned. Black top was observed cracked with raised edges. There was a large dirt area with uneven ground. LPA observed 3 tricycles as the outdoor equipment with 2 of the tricycles missing the plastic handles. There were 4 other infant/toddler tricycles and 2 infant toddler play structures that were not age appropriate for the children in care. Required shade and fencing were inspected. There is a large tree providing shade in the play area. 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. Teachers from other programs are not eligible to supervise the children for the state preschool program. Waiver discussed if programs will share the same play space as per staff they currently share the space with another program.
Page 2 of 4

NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Claudia Kam
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2026

LIC809 (FAS) - (06/04)

Page: 3 of 14

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: 99TH STREET ELEMENTARY SCHOOL CSPP/HEAD START	FACILITY NUMBER: 197416902
	VISIT DATE: 06/02/2026

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

The children have access to their disposable water bottles during outside play. Bubblers in the outdoor play are have been shut off. 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. Personal Rights of children were observed by LPA.

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 11/2023 for staff. Staff present did not have proof of current 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.

Page 3 of 4

NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Claudia Kam
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2026

LIC809 (FAS) - (06/04)

Page: 4 of 14

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: 99TH STREET ELEMENTARY SCHOOL CSPP/HEAD START	FACILITY NUMBER: 197416902
	VISIT DATE: 06/02/2026

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

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.

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 6/2/2026.

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, Teacher Ms. Gardner

Page 4 of 4

NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Claudia Kam
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2026

LIC809 (FAS) - (06/04)

Page: 5 of 14

Document Has Been Signed on 06/02/2026 03:05 PM - It Cannot Be Edited

Created By: Claudia Kam On 06/02/2026 at 02:28 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: 99TH STREET ELEMENTARY SCHOOL CSPP/HEAD START	FACILITY NUMBER: 197416902
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/02/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101239(m)(1)

Fixtures, Furniture, Equipment and Supplies

(1) The licensee shall provide a variety of age-appropriate equipment, toys and materials in good condition and in sufficient quantity to allow children present to fully participate in planned activities. 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 which poses a potential health, safety or personal rights risk to persons in care. The furnishings for indoor and outdoor are not age appropriate for the children in care. Outdoor equipment is not sufficient.
	POC Due Date: 09/30/2026
	Plan of Correction
1 2 3 4	Facility representative will acquire additional materials and equipment by 9/30/2026.

Type B

Section Cited

CCR

101239(f)(1)

Fixtures, Furniture, Equipment and Supplies

(f) Solid waste shall be stored, located and disposed of in a manner that will not transmit communicable diseases or odors, create a nuisance, or provide a breeding place or food source for insects or rodents. (1) All containers used for storage of solid wastes, including moveable bins, shall have a tightfitting cover that is kept on; shall be in good repair; and shall be leakproof and rodent-proof. 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 which poses a potential health, safety or personal rights risk to persons in care. Trash can does not have a tight fitting lid and trash is not disposed of immediately after each meal
	POC Due Date: 09/30/2026
	Plan of Correction
1 2 3 4	Facility representative will purchase a new trash can by 9/30/2026.

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: 06/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2026

LIC809 (FAS) - (06/04)

Page: 6 of 14

Document Has Been Signed on 06/02/2026 03:05 PM - It Cannot Be Edited

Created By: Claudia Kam On 06/02/2026 at 02:28 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: 99TH STREET ELEMENTARY SCHOOL CSPP/HEAD START	FACILITY NUMBER: 197416902
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/02/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101238.2(d)

Outdoor Activity Space

(d) The surface of the outdoor activity space shall be maintained: 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 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/30/2026
	Plan of Correction
1 2 3 4	Facility representative will update the outdoor play space by 9/30/2026.

Type B

Section Cited

101804(e)

Care for Toddlers within a Licensed Preschool Center

(e) The department may approve alternate use of outdoor play space to achieve separation from preschool children or infants if necessary to protect the safety of children in care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. There is no waiver on file for a shared outdoor play space.
	POC Due Date: 08/14/2026
	Plan of Correction
1 2 3 4	Facility representative will have the other program play on the other play ground or submit a waiver for a shared play space by 9/30/2026.

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: 06/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2026

LIC809 (FAS) - (06/04)

Page: 7 of 14

Document Has Been Signed on 06/02/2026 03:05 PM - It Cannot Be Edited

Created By: Claudia Kam On 06/02/2026 at 02:28 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: 99TH STREET ELEMENTARY SCHOOL CSPP/HEAD START	FACILITY NUMBER: 197416902
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/02/2026

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 observation, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. 3 of 3 staff did not have current mandated reporter.
	POC Due Date: 09/30/2026
	Plan of Correction
1 2 3 4	Staff will complete mandated reporter by 9/30/26.

Type B

Section Cited

CCR

101216(f)

Personnel Requirements

(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview, record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. 3 of 3 staff did not have current CPR.
	POC Due Date: 09/30/2026
	Plan of Correction
1 2 3 4	Staff will complete CPR and submit by 9/30/2026.

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: 06/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2026

LIC809 (FAS) - (06/04)

Page: 8 of 14