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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018016
Report Date: 08/22/2024
Date Signed: 08/22/2024 02:12:50 PM

Document Has Been Signed on 08/22/2024 02:12 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:PEACE OF MIND PRESCHOOLFACILITY NUMBER:
198018016
ADMINISTRATOR/
DIRECTOR:		SIMONE JONESFACILITY TYPE:
850
ADDRESS:240-250 S. PARCELS ST.TELEPHONE:
(909) 629-0600
CITY:POMONASTATE: CAZIP CODE:
91766
CAPACITY: 32TOTAL ENROLLED CHILDREN: 32CENSUS: 6DATE:
08/22/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Director Jerry LewisTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On 8/22/2024 at 2:30 pm Licensing Program Analyst (LPA), Stephanie Li conducted an unannounced Proof of Correction (POC) inspection to ensure the deficiencies cited on 7/12/2024 during an Annual visit have been corrected. A COVID risk assessment was conducted. LPA met with Director Jerry Lewis and LPA observed 6 children in care with 3 adults.

During the visit, LPA observed that sign in and our sheets were current with parent full signatures and reflect the correct dates. LPA observed a reminder sign posted next to the sign in binder, reminding parents to sign in and out their children daily. LPA was provided proof of MMR and TDAP immunization records for one staff present during the annual inspection.

LPA cleared the deficiencies on this date and issued Proof of Correction (POC) clearance letters during the visit.

At this time, the facility is in compliance with California Code of Regulations Title 22. Therefore, no deficiencies are being cited.

A notice of site visit was given to Licensee and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director Jerry Lewis.



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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2024
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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