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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198014651
Report Date: 10/09/2025
Date Signed: 10/09/2025 02:15:49 PM

Document Has Been Signed on 10/09/2025 02:15 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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:WILSHIRE BOULEVARD TEMPLEFACILITY NUMBER:
198014651
ADMINISTRATOR/
DIRECTOR:		FLORYN ROSENBERGFACILITY TYPE:
850
ADDRESS:3663 WILSHIRE BLVD.TELEPHONE:
(213) 388-2401
CITY:LOS ANGELESSTATE: CAZIP CODE:
90010
CAPACITY: 225TOTAL ENROLLED CHILDREN: 225CENSUS: 70DATE:
10/09/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Floryn RosenbergTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Seung Lee conducted an unannounced annual random inspection. Upon arrival, LPA Lee met with designated facility Site Supervisor, Floryn Rosenberg. This is a preschool age program with a toddler program that is licensed for 225 children. The facility operates Monday – Friday from 7:45 AM – 5:00 PM. Per the Site Supervisor, there are children 119 enrolled. Preschool and toddler components are conducted in physically separate areas both indoors and outdoors.

During the tour with Site Supervisor, Floryn Rosenberg. All areas identified on the facility sketch were inspected. LPA observed 23 children with 3 staff in in the outdoor play area. 14 children with 4 staff members in the toddler room, and 33 staff members with 4 staff members in the outdoor dining area. Teacher to child ratios were observed. The Licensee is within the conditions, limitations, and capacity specified on the license. Staff names were recorded. Criminal Record Clearances were reviewed. During this inspection, all children were observed to be under visual supervision of a teacher at all times.

LPA observed required forms to be posted on the Parent Board located near entrance of facility. LPA observed the following: Facility License, Snack Menus, LIC 613A Personal Rights, PUB 269 Child Car Seat Poster, PUB 369 Notification of Parent's Rights, and LIC 610 Emergency Disaster Plan. LIC 9148 Earthquake Preparedness and Verification of Disaster and Fire Drills were reviewed, Last disaster drill with children was conducted on 09/18/2025 per Director .


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NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Seung Lee
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/09/2025
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.

LIC809 (FAS) - (09/23)
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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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: WILSHIRE BOULEVARD TEMPLE
FACILITY NUMBER: 198014651
VISIT DATE: 10/09/2025
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LPA observed the facility to be clean, safe, sanitary and in good repair. Furniture and equipment was inspected for good repair, free of sharp, loose, or pointed parts. All surfaces and materials accessible to children, including toys, are toxic free. All toilets are in safe, sanitary and in good repair. All classroom floors were observed to be safe and clean. Director’s office is used as an isolation area. Parents are contacted immediately when children are determined to be ill and staff are ensuring that children with obvious symptoms of illness are not being accepted. Snack menus were reviewed to ensure that they are being posted at least one week in advance and visible to an authorized representative. The facility provides AM snack and PM snack. Children bring their own lunches. LPA observed jugs of water and disposable cups available for drinking water and children's individual water bottles. All containers used for storage of solid wastes have a tight fitting cover on and are in good repair. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are stored in an area inaccessible to children. Storage areas for poisons are locked. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements.

Outdoor play equipment was observed to be in good condition, free of sharp, loose or pointed parts. LPA observed age appropriate toys and equipment. The areas around and under high climbing equipment, slings or slides have cushioning material that absorb a fall. Outdoor activity space surface is maintained in a safe condition as is free of hazards. The Director states that there are no bodies of water on the premises and LPA did not observe any bodies of water during this. Director states there are no weapons or firearms on the premises. Transportation services are not provided at this facility. Sign in and out sheets were reviewed to ensure that the person who signs the child in and out uses their full legal signature and records the time of the day. LPA observed all children present to be signed in. Staff Records were reviewed to ensure the following are present: Staff qualifications, proof of immunization’s, current Pediatric First Aid & CPR certification, TB Clearance or Risk Assessment, LIC 503 Health Screening Report, LIC 508 Criminal Record Statement, LIC 9108 Statement Acknowledging Requirement to Report Child Abuse, Mandated Reporter Certificate and the LIC 9052 Notice of Employee’s Rights.Children’s Records were reviewed to ensure that the following are present: LIC 613A Personal Rights, Admission Agreement, LIC 700 Identification and Emergency form, LIC 701 Physician’s Report, LIC 995 Notification of Parent’s Rights, LIC 627 Consent for Emergency Medical Treatment and Immunization Record.


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NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Seung Lee
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: WILSHIRE BOULEVARD TEMPLE
FACILITY NUMBER: 198014651
VISIT DATE: 10/09/2025
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This facility provides Incidental Medical Services – IMS. Per Director, there are no children on medications. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

Director was reminded that all adults 18 and over, 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 Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

There were no deficiencies observed during the inspection on this date.

The notice of site inspection must remain posted for a period of 30 days during hours of operation. Failure to maintain this posting requirement may result in a civil penalty of $100.00 dollars.

Exit interview conducted with Director. Appeal rights discussed and explained.

NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Seung Lee
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
LIC809 (FAS) - (06/04)
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