198010494-4-15-2025-54-CC-AMOY-DFRUA4-20250415152408

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198010494
Report Date: 04/15/2025
Date Signed: 04/15/2025 03:24:15 PM

Document Has Been Signed on 04/15/2025 03:24 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:	SOUTHLAND CHRISTIAN PRESCHOOL		FACILITY NUMBER:	198010494
ADMINISTRATOR/ DIRECTOR:	RAMIREZ, BETTY		FACILITY TYPE:	850
ADDRESS:	16400 WOODRUFF AVE		TELEPHONE:	(562) 867-8594
CITY:	BELLFLOWER	STATE: CA	ZIP CODE:	90706
CAPACITY: 84	TOTAL ENROLLED CHILDREN: 61	CENSUS: 52	DATE:	04/15/2025
TYPE OF VISIT:	Case Management - Annual Continuation	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:30 PM
MET WITH:	Betty Ramirez, Director		TIME VISIT/ INSPECTION COMPLETED:	04:00 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 (LPAs) Alicia Mooberry and Tyler Reyes conducted an unannounced Case Management - Annual Continuation inspection of the above facility for the purpose of reviewing facility files and following up on Plans of correction for deficiencies cited on 4/10/25.

Upon arrival LPAs met with Director Betty Ramirez, and explained the purpose of the visit. This is a preschool program located on the premises of a church and has a separate private school on site. LPAs observed 52 children in the process of napping in "Lab" / Rm 1, supervised by 4 staff. Staff present have obtained the required background clearance and are associated to facility.

During this inspection LPA Mooberry inspected the bathrooms in Room 1 and by the outdoor play area, bathrooms are clean and free from hazards, LPA received document that showed pest control visited facility on 4/14/25. LPA inspected the playground and observed the equipment that is free of hazards. Deficiencies cited on 4/10/25 has been cleared and letters provided to facility representative. LPA Reyes completed file review of staff and children. The following was recorded: 1 out of 7 staff are missing both proof of immunization against MMR and TB clearance posing a potential risk to the health of children in care. Director was reminded to maintain facility files current and organized.

Facility Representative was advised of Technical Support Program offered by department to support in the following required regulations. LPA provided PUB 394 Notification of Parents Rights poster with updated Regional Office name.

Per Title 22 regulations, 2 B deficiencies are cited today 4/15/2025.

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 Betty Ramirez appeal rights were provided. -------------End of Report

NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Alicia Mooberry
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025

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 3

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 3

Document Has Been Signed on 04/15/2025 03:24 PM - It Cannot Be Edited

Created By: Alicia Mooberry On 04/15/2025 at 02:57 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: SOUTHLAND CHRISTIAN PRESCHOOL	FACILITY NUMBER: 198010494
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/15/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 1 out of 7 staff records did not have proof of immunization againt measles (MMR) which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/25/2025
	Plan of Correction
1 2 3 4	Per Director, proof of MMR immunization for Staff # 3 will be obtained and sent to LPA by POC due date.

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
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in 1 out of 7 staff did not have proof of TB clearance which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/25/2025
	Plan of Correction
1 2 3 4	Per Director, proof of Tuberculosis (TB) clearance for Staff # 3 will be obtained and sent to LPA by POC due 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.

	Denise Gibbs
NAME OF LICENSING PROGRAM MANAGER:

	Alicia Mooberry
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025

LIC809 (FAS) - (06/04)

Page: 3 of 3