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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019052
Report Date: 03/04/2026
Date Signed: 03/04/2026 11:53:18 AM

Document Has Been Signed on 03/04/2026 11:53 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:POMONA HIGH CHILD DEVELOPMENT CENTER, ROOM P88FACILITY NUMBER:
198019052
ADMINISTRATOR/
DIRECTOR:		KYM ALLENFACILITY TYPE:
850
ADDRESS:475 BANGOR ST.TELEPHONE:
(909) 397-4438
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY: 23TOTAL ENROLLED CHILDREN: 23CENSUS: 13DATE:
03/04/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Michelle Smith Program Admin
Erika Diaz Teacher		TIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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This incident took place under Pomona High Child Development Center RM P88 facility number 198019052. OD LPA placed under incorrect facility number

Licensing Program Analyst (LPA) Kamile Martin conducted an unannounced Case Management Inspection due to an incident that occurred on 2/19/26 and was reported to the Department on 2/23/26 LPA met with Program Assistant Michelle Smith whom the reason for the visit was explained. Program Assistant guided LPA on a tour of the facility LPA observed preschool classroom rm P 88 indoors and outdoor play area. There are 13 children present and 2 teaching staff present. In Infant classroom 85 there are 5 children present an 3 staff present. In the toddler classroom there are 6 toddlers present and 2 staff present. The facility was observed to be operating within the license capacity limitations.

On 2/19/26 an unusual incident report was made to the Department regarding A child (1)shared with her mother when on the playground with another child (2) touched her inappropriately in her private area. No adults witnessed the incident. FSA Meikol Holden called the mandated reporter hotline and was provided with a claim number. (claim A20260220-438443.)

NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Kamile Martin
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2026
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: POMONA HIGH CHILD DEVELOPMENT CENTER, ROOM P88
FACILITY NUMBER: 198019052
VISIT DATE: 03/04/2026
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Teaching staff spoke with LPA Kmartin regarding what they know of what occurred during 2/19/26. It was disclosed that child #1 did not speak with teaching staff about the incident the day the incident occurred. There are 2 playground times throughout the day a morning and a afternoon outdoor time.

Teachers followed supervision protocol. LPA observed the playground and there are no places for children to hide. Teaching staff described child #1 personality and character traits. And child #2 personality and character traits. LPA received copies of DRDP observation books on both children. And child#1 Parent conferences and ASQ questionnaire first and last page.

During today’s visit, LPA observed children in the preschool environment, reviewed sign in sheets for preschool, Infant, and toddler’ programs. Observed the playground for preschool children and discussed with Program administrator Michelle Smith the policies and procedures at the facility. While speaking with teaching staff it was revealed there are video cameras on site, facing the preschool playground, and one outside of the entryway gate. Per Program administration, LPA would have to ask the High School Administration to review the video footage she does not have access.

Based on information obtained during the investigation, Policies and procedures were followed and teaching staff were interviewed. Per Program Administrator and teaching staff, disclosed that child#1 is no longer enrolled as of 2/20/26. Cameras are available of the playground where the alleged incident occurred. A follow up visit is necessary to review video footage. LPA has to obtain permission to view the video footage through Pomona High Administration.

A notice of site visit was given and must remain posted for 30 days . Failure to comply with posting requirements shall result in an immediate civil penalty of $100.00

Exit interview conducted and report was reviewed with Erika Diaz.

NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Kamile Martin
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2026
LIC809 (FAS) - (06/04)
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