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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019526
Report Date: 04/04/2023
Date Signed: 04/04/2023 03:24:01 PM

Document Has Been Signed on 04/04/2023 03:24 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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:FULL GOSPEL CHILD DEVELOPMENT CENTER PRESCHOOLFACILITY NUMBER:
198019526
ADMINISTRATOR:ADALINA HERRERAFACILITY TYPE:
850
ADDRESS:10700 S. SAN PEDRO STTELEPHONE:
(323) 756-1975
CITY:LOS ANGELESSTATE: CAZIP CODE:
90061
CAPACITY: 15TOTAL ENROLLED CHILDREN: 15CENSUS: DATE:
04/04/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Christian Seymour, DirectorTIME COMPLETED:
03:40 PM
NARRATIVE
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Licensing Program Analysts (LPAs), Denise Gibbs and Rosaura Valenzuela conducted an unannounced Plan of Correction(POC) visit on April 4, 2023 at 1:00 PM. LPAs met with Christian Seymour.

LPA's toured facility and reviewed staff files to ensure the deficiency cited on 3/14/23 is cleared. There were seven preschool children and four school age children when LPAs arrived. LPA observed one qualified staff who is the Director and two assistants supervising children which clears the deficiency cited on 3/14/23. LPAs observed that facility is working out of licence limits. Facility does not have a license to care for school age children.

During inspection LPAs observed that the structure of the physical plant has been changed from original design on the Licensing Form (LIC)999- Facility Sketch. Facility sketch shows that classroom should be divided into three spaces, two for preschool and one for toddlers. LIC999 shows that there was a separate entrance for preschool and toddlers. The LIC999 also shows that there are two yards outdoors, one for preschool and one for toddlers. LPAs observed that all walls/barriers in the classroom have been taken down, the toddler area has recently been sectioned off to provide a separate space but there is only one entrance for toddlers and preschool and the there is only one yard outdoors being used for children. The smaller yard (toddler yard) is observed to be used as storage. Licensee did not report structural change in a timely manner. LPAs remeasured the facility due to structural change.
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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE: DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
Document Has Been Signed on 04/04/2023 03:24 PM - It Cannot Be Edited


Created By: Denise Gibbs On 04/04/2023 at 10:20 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: FULL GOSPEL CHILD DEVELOPMENT CENTER PRESCHOOL
FACILITY NUMBER: 198019526

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/28/2023
Section Cited
CCR
101212(c)

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101212(c) Reporting Requirements
(c) The licensee shall notify the Department in writing of his/her intent prior to making any structural changes...of indoor or outdoor activity space. Such structural changes shall include, but not be limited to, room additions.
This requirement was not met as evidence by:
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Per Director, she will discuss reporting requirements with licensee. Licensee will email LPA Unusual Incident Report by POC date 4/30/23.
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Based on observation the licensee did not ensure the that structural changes were reported to the department. This poses a potential health and safety risk to children in care.
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Type B
04/28/2023
Section Cited
CCR101239.1(b)(5)

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101239.1 Napping Equipment
(b) Floor mats used for napping shall be:
(5) Maintained in a safe condition with no exposed foam.

This requirement was not met as evidence by:
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Per Director, they will put the ripped matts in the trash and sent LPA a picture of the cabinet with only the new matts by POC date 4/28/23/
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Based on observation the licensee did not ensure the that structural changes were reported to the department. This poses a potential health and safety risk to children in care
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Karen Chambers
LICENSING EVALUATOR NAME:Denise Gibbs
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2023


LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 04/04/2023 03:24 PM - It Cannot Be Edited


Created By: Denise Gibbs On 04/04/2023 at 10:58 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: FULL GOSPEL CHILD DEVELOPMENT CENTER PRESCHOOL
FACILITY NUMBER: 198019526

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/05/2023
Section Cited
CCR
101161(a)

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101161(a) Limitations on Capacity and Ambulatory Status
(a) A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.

This requirement was not met as evidence by:
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Per Director, She will find placement for the school Age children in care. LPA will conduct follow up visit to clear deficiencies.
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Based on observation the licensee did not ensure the facility operated within its limitations. Licensee is providing care for two school-age children. This poses an immediate health and safety risk to children in care.
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Type A
04/05/2023
Section Cited
CCR101238(a)

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101238(a)Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

This requirement is not met as evidenced by:
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Knives and Lysol wipes were made inaccessible during inspection. Per Director, she will discuss construction on front entrance door with licensee and provide a picture of how entrance was made safe for children. Director will also email plan or picture to patch up holes in dry wall, by POC date 4/5/23.
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Based on observation, the licensee did not comply with the section cited above, which poses an immediate health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Karen Chambers
LICENSING EVALUATOR NAME:Denise Gibbs
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2023


LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: FULL GOSPEL CHILD DEVELOPMENT CENTER PRESCHOOL
FACILITY NUMBER: 198019526
VISIT DATE: 04/04/2023
NARRATIVE
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While LPA's toured the kitchen, sealed medication, Defend Cold and Mucus, Colic tablets and Pedialyte accessible to children in care. In the classroom, LPAs observed a package of Lysol wipes on a low toy self, accessible to children. The door frame around the main entrance door was observed to be in disrepair. There is exposed wood, cracks and chipping paint along the door frame inside and out. LPAs also observed outlets without safety covers, chipped paint and holes in the dry wall in the classroom. This is an immediate health and safety risk to children in care.

During nap time LPAs observed staff setting up and children laying on matts that were ripped with exposed foamt. During a previous inspection LPA observed children napping on new matts. LPA asked staff to provide children with new matt. New matts were provided during inspection. LPA advised that the ripped matts be thrown away.

Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Facility Representative, Christian Seymour.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 04/04/2023 03:24 PM - It Cannot Be Edited


Created By: Denise Gibbs On 04/04/2023 at 02:15 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: FULL GOSPEL CHILD DEVELOPMENT CENTER PRESCHOOL
FACILITY NUMBER: 198019526

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/04/2023
Section Cited
CCR
101226

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101226 Health-Related Services
(e) In centers..(1)All prescription and nonprescription medications shall be centrally stored in accordance with the requirements specified below:(A) Medications shall be kept in a safe place inaccessible to children.
This requirement was not met as evidence by:
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Cleared during inspection
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Based on observation, the licensee did not comply with the section cited above, which poses an immediate health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Karen Chambers
LICENSING EVALUATOR NAME:Denise Gibbs
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2023


LIC809 (FAS) - (06/04)
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