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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019207
Report Date: 06/02/2026
Date Signed: 06/02/2026 11:44:46 AM

Document Has Been Signed on 06/02/2026 11:44 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:BUSHNELL WAY ELEMENTARY CSPPFACILITY NUMBER:
198019207
ADMINISTRATOR/
DIRECTOR:
LILIANA NARVAEZFACILITY TYPE:
850
ADDRESS:5507 BUSHNELL WAYTELEPHONE:
(323) 255-6511
CITY:LOS ANGELESSTATE: CAZIP CODE:
90042
CAPACITY: 20TOTAL ENROLLED CHILDREN: 9CENSUS: 8DATE:
06/02/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Lilian Narvaez, Principal TIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Roxana Lopez conducted an unannounced annual random inspection. LPA met with Facility Representative Principal Liliana Narvez, who the purpose of this inspection was announced to. This is an LAUSD state preschool program located in RM K2 on the premises of Bushnell Way Elementary School. Facility operation hours are Monday through Friday from 7:45 AM to 2:15 PM with early dismissal on Tuesdays. Per Facility representative they currently have 9 children enrolled.

All areas identified on the Facility Sketch were inspected. Upon arrival, the following staff were present during this inspection: Staff #1 and #2 with 8 preschoolers. The following was observed during the tour of the facility:

Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Children have their own cubby to store their belongings. Isolation area is located in the nurses office.

Age appropriate sinks and toilets were inspected for availability and good repair in the restroom. Waiver is on file to share restrooms with Kindergarten. LPA observed that the classroom has carbon monoxide detector which was tested and is in operable condition. General sanitation was observed. Availability of indoor water bottles was observed inside classroom. -------------------------------------------------- pg. 1 of 4 ----------------------------------------------------

NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Roxana Lopez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/02/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 3 of 3
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: BUSHNELL WAY ELEMENTARY CSPP
FACILITY NUMBER: 198019207
VISIT DATE: 06/02/2026
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Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children in all areas.

All kitchen areas/food preparation areas and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair.

Outdoor playground equipment is in safe condition, free of sharp, loose or pointed parts. There is adequate shade in the play yard. Per Teacher, children take their water bottles outside. Waiver is on file to share yard.

All individuals present have obtained a criminal record clearance or criminal record exemption. All staff have received an active criminal record clearance as a condition of their employment with the Los Angeles Unified School District. There is at least one person trained in CPR and Pediatric First Aid present during this inspection.

Staff present have a current AB1207 Mandated Reporter certificate on file.

LPA Lopez did not review complete staff files during the inspection due to the staff files being stored at the administrative office. LPA will review staff files at a later time and date. If staff files were to be incomplete during the time and date that LPA reviews files, a case management inspection will occur at the facility to reflect the incomplete files.

Children’s Records were reviewed for completeness; In review of children’s records, files contain information 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.

Children's roster was reviewed. Sign-In and Sign-Out sheets were reviewed. Children present were signed in. Disaster drill log was available, last drill was conducted on 5/1/26. -------- pg. 2 of 4 ------

NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Roxana Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2026
LIC809 (FAS) - (06/04)
Page: 1 of 1
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: BUSHNELL WAY ELEMENTARY CSPP
FACILITY NUMBER: 198019207
VISIT DATE: 06/02/2026
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Food Menus are posted one week in advance where it is visible by the child's authorized representative. Menus for the past 30 days are available upon request. Preschoolers are provided with breakfast, lunch, snack by the Los Angeles Unified School District.

First Aid supplies were observed in the classroom stored inside a cabinet.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22- 02-CCP. When any IMS is provided, a Plan for Providing 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)/ (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test as specified in Health and Safety Code section 1597.16. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP.). LPA verified that the lead testing was completed in accordance to the Written Directives (Interim Licensing Standards) outlined in PIN 21-21.1-CCP. CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES,

Facility representative 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.

------------------------------------- pg. 3 of 4 ------------------------------------------------------------------------

NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Roxana Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2026
LIC809 (FAS) - (06/04)
Page: 1 of 1
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: BUSHNELL WAY ELEMENTARY CSPP
FACILITY NUMBER: 198019207
VISIT DATE: 06/02/2026
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Facility representative 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.

LPA advised the Principal to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

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, the facility is in compliance with California Code of Regulations Title 22. No deficiencies cited. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with facility representative, Liliana Narvaez.

---------------------------------------------------- pg. 4 of 4 --------------------------------------------------

NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Roxana Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2026
LIC809 (FAS) - (06/04)
Page: 1 of 1