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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015434
Report Date: 07/25/2024
Date Signed: 07/25/2024 11:47:24 AM

Document Has Been Signed on 07/25/2024 11:47 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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:IMMACULATE CONCEPTION PRESCHOOLFACILITY NUMBER:
198015434
ADMINISTRATOR/
DIRECTOR:		JUDY VIRGINIA GONZALEZFACILITY TYPE:
850
ADDRESS:830 GREEN AVENUETELEPHONE:
(213) 382-5931
CITY:LOS ANGELESSTATE: CAZIP CODE:
90017
CAPACITY: 20TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
07/25/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Bianka Miranda, Director TIME VISIT/
INSPECTION COMPLETED:
11:50 AM
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On Thursday, July 25,2024 Licensing Program Analyst (LPA) Staicy Perry conducted an unannounced annual inspection and met with Director Bianka Miranda who guided LPA Perry on a tour of the facility. The preschool is located on the property of a private school campus.

This is a preschool program that serves children ages 2 to 3 years old. This program operates Monday to Friday 7:30 a.m. – 6:00 p.m. for normal business hours and currently director stated that summer hours are M-F 8:30-5:00pm. Prior to entering the building parents and visitors must enter and ring the doorbell and wait for the school receptionist to answer. Sign in and out takes place at the main entrance area of the classroom. All areas identified on the facility sketch were toured and inspected both indoors and outdoors. Teacher and child ratio were observed, and present staff are fingerprinted cleared.



LPA entered Preschool classroom. LPA Perry observed 0 children and 0 staff present. LPA observed age-appropriate furniture and equipment to be in good condition, free of sharp, not loose, or pointed parts and age-appropriate toys accessible to children. LPA observed a cubby for children to store their personal belongings located at the entrance of the classroom. LPA observed cleaning solutions stored inside the teachers closet making it inaccessible for children to reach and open. LPA Perry observed a step trash bin with a lid. LPA observed a wall AC unit. LPA also observed 2 drinking fountains located on the wall next to the restroom.

Heating, lighting, and ventilation were evaluated by LPA Perry. LPA observed wall AC. LPA observed the fire extinguisher located in the doorway of the classroom before entering and the valve on the required 2A10BC fire extinguishers indicating fully charged and serviced on 01/1/9/2024. Smoke detectors were not tested during this visit due to the detectors being wired to the emergency pull down fire alarm system. Carbon monoxide detectors in was observed in the classroom and is hard wired. LPA Perry did not test. The last emergency drill was conducted on 5/20/24. LPA observed napping equipment to be in the form of cots to be in good condition and stored in the classroom. First aid kit supplies are kept inside the classroom and LPA observed the kits to be fully equipped. During this visit, Director Bianka, currently has no children with medication or severe food allergies. LPA Perry asked if there were any poisons, firearms, weapons, or bodies of water. Director Bianka stated no firearms, weapons, no poisons nor bodies of water. LPA did not observe firearms or weapons, poisons, nor bodies of water. Director Bianka stated the ill isolation area takes place in the main office and children will utilize staff restroom.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Staicy Perry
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2024
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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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: IMMACULATE CONCEPTION PRESCHOOL
FACILITY NUMBER: 198015434
VISIT DATE: 07/25/2024
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Classroom restroom was reviewed next, LPA Perry observed the restrooms to be in good condition with working toilets, sinks, hand soap dispenser and paper towels. LPA observed a total of 2 toilets and 2 hand washing sinks. LPA also observed the diaper station to be located inside the restroom and the diaper changing mat to be a child size sleeping mat that dose no have raised sides, A technical violation issued and declaration obtained. Restroom was also observed to have stored food (snacks, chips in individual bags) and water bottles in the restroom stored. LPA advised director to remove food from the restroom area. A technical violation issued and declaration obtained.

LPA Perry entered the outdoor play area. LPA Perry observed 10 children and 3 staff observing the children. LPA Perry observed the equipment to be in a safe condition, free of sharp, no lose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. LPA Perry observed play structure equipment to be age appropriate for ages 2-5 years and areas around or under high climbing equipment, are cushioned with a rubber mat that may absorb a fall. For adequate shade, LPA Perry observed a shade oning. LPA observed the playground yard to be fenced and the side gate closed. LPA observed 2 trash bins with tight lids. For outdoor water drinking, children bring their personal water bottles.


This program provides breakfast, lunch, and pm snack during normal school months. Meals and snacks are provided by the parent during the summer months. LPA observed extra snacks for the children for emergency. LPA Perry informed director that any food brought from the children's homes, the container shall be labeled with the child's name and properly stored or refrigerated. For water drinking, LPA Perry observed children’s personal water bottles in the classroom. LPA observed the food preparation area to be clean and free of litter, rubbish, rodents, and/or any other vermin and storage containers for solid waste, including trash bins with lid covers that are kept on, and in good repair. The facility was observed to be free of flies, other insects, and rodents. Lead testing was conducted on 7/23/24 and is pending results.

The following documents were posted in a prominent, publicly accessible area at the facility: Facility License, Notification of Parents' Rights (PUB 393), Personal Rights (LIC 613A), Menu, and Earthquake Preparedness (LIC 9148). PUB 269 Child Passenger System Poster, and Daily Schedule. LPA Perry observed sign in/out sheets.

LPA Perry reviewed the children’s roster, children’s files and observed the files to be complete. Staff files were observed to be incomplete. S#3 file was incomplete. LPA advised director to have S#3 file complete. A technical violation issued, and declaration obtained. Per director staff is only here for the summer program assisting (July 1-July 26, 2024.) LPA explained file still must be complete. Director understood. Declaration obtained. LPA observed teacher fill out forms and place in file.

LPA Perry observed director Pediatric First Aid/CPR certification which expires on 8/2025, Preventative Health and Safety certification dated June 13, 2024, and has proof of immunization against Pertussis, MMR, and Influenza declination. CCLD orientation on file for director dated June 1, 2024. Director has completed the mandated reporter (AB 1207) training dated 10/19/25. Director was advised that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Staicy Perry
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
LIC809 (FAS) - (06/04)
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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: IMMACULATE CONCEPTION PRESCHOOL
FACILITY NUMBER: 198015434
VISIT DATE: 07/25/2024
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Items discussed during this visit:

1. The following items are prohibited by Licensing: Refused Entry to a Facility or Any Part of a Facility is a violation of Section 1596.852, 1596.853 or 1597.09. Regulations 101238 (g) (2), The Presence of an Excluded Individual, Fire Clearance Violations, Accessible Bodies of Water, Accessible Firearms, Ammunition or Both

2. Breakfast/Lunch/Snack Menus: Menus are required to be posted one week in advance where it is visible by the child's authorized representative. Menus for the past 30 days must also be available upon request.

3. Current Children’s Roster: Each childcare facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician. This roster shall be available to the licensing agency upon request.



4.LIC 311A - Records to be Maintained at the Facility: LPAs advised that forms, regulations, and quarterly updates can be accessed on the Child Care Licensing website at: www.ccld.ca.gov.

5.Pediatric First Aid and CPR: At least one person trained in Pediatric First Aid and CPR and EMSA approved must be present.

6.Designated Staff: The name of the childcare center director or fully qualified teacher(s) designated to act in the director's absence must be on file.

7.Qualifications: Educational background, training, and/or experience for each staff present must be available for review

8. Immunization Requirements: 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 or influenza declination

9.Children’s Records: must be available for review; including but not limited to, the following: Name, address, and telephone number of the child's authorized representative and of relatives or others who can assume responsibility for the child if the authorized representative cannot be reached when necessary.

10.Staff Records: must be available for review; background clearance, LIC 503 Health Screening report, LIC 9108 Statement Acknowledging Requirement to Report Child Abuse, Staff Qualifications, LIC 9050 Employee Rights, LIC 501 Personnel Record, AB 1207 Mandated Child Abuse Certification, MMR, TDAP, TB, influenza or influenza declination.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Staicy Perry
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
LIC809 (FAS) - (06/04)
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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: IMMACULATE CONCEPTION PRESCHOOL
FACILITY NUMBER: 198015434
VISIT DATE: 07/25/2024
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Criminal Record Clearance - Bianka 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.

CCC COMPLETED SAMPLING BUT THE TEST RESULTS ARE NOT YET AVAILABLE.

LPA referred director to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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/.

MyChildCarePlan.org –Director 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.

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.


At this time, above facility is in compliance with Title 22 Regulations and no deficiencies will be cited at this time.

Notice of Site Visit - A notice of site visit was given and must remain posted for 30 days. Failure to maintain posting as required will result in a $100.00 civil penalty.

Exit interview conducted and report was reviewed with Director Bianka. Appeal rights discussed and provided.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Staicy Perry
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
LIC809 (FAS) - (06/04)
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