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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020175
Report Date: 03/11/2025
Date Signed: 03/11/2025 12:46:23 PM

Document Has Been Signed on 03/11/2025 12:46 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:KIDSZONE PRESCHOOL ACADEMYFACILITY NUMBER:
198020175
ADMINISTRATOR/
DIRECTOR:		YVONNE WITHERSFACILITY TYPE:
830
ADDRESS:1206 LINCOLN AVETELEPHONE:
(626) 345-5922
CITY:PASADENASTATE: CAZIP CODE:
91103
CAPACITY: 18TOTAL ENROLLED CHILDREN: 18CENSUS: 15DATE:
03/11/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Infant teacher Jasmin LugoTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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On 3/11/25 at 9:00am, Licensing Program Analyst (LPA) Stephanie Li conducted an unannounced annual inspection. Upon arrival, LPA met with Lead Teacher Jasmin Lugo who is designated to receive licensing and led LPA on a tour of the facility. This is an Infant center with a toddler component. The facility also has a preschool license. Per teacher, there are currently 8 children enrolled in the Infant program and 10 children in the toddler program. Hours of operation are Monday-Friday 7:00am-6:00pm.

All areas identified on the Facility Sketch were inspected. The infant facility consists of 2 classrooms and 1 playground. The following was observed: Infant room had 6 infants and 2 staff. Toddler room had 9 toddlers and 2 staff. Staff names were recorded. Teacher-child ratios were observed to be in accordance with Title 22 regulations. The Licensee is within the conditions, limitations, and capacity specified on the license. All children were observed to be under active/visual supervision of a teacher during the tour.

Licensing staff observed disinfectants, cleaning solutions, medication and other items that are dangerous to children were not accessible to children. Classroom furniture and equipment are in good condition, free of sharp, loose, or pointed parts. All floors are clean and safe. Napping equipment cots, cribs and bedding were inspected for good condition, appropriate storage, and cleanliness. Storage for children's belongings were inspected. All toilets and washing facilities are in safe and sanitary operating conditions. First Aid supplies are available and complete. Drinking water is available and provided through 1 gallon water jugs. The director’s office is used as the sick area for an ill child to rest. There is a staff bathroom available near the office for an ill child to use.

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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2025
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: KIDSZONE PRESCHOOL ACADEMY
FACILITY NUMBER: 198020175
VISIT DATE: 03/11/2025
NARRATIVE
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Cribs and napping equipment were observed in the infant program. LPA observed portable cribs that meet Consumer Product Safety Commission safety standards. Cribs were observed to be free of loose items. Cots were available for infants who can climb out of crib. Sleeping area is physically separated, however 2 cribs were observed not in the sleeping area. Sleeping wall was observed to limit staff’s ability to watch sleeping infants at all times. Per Teacher, they will re-arrange the classroom so that the cribs are in the designated separated sleeping space and all beds are visible to staff. Per teacher, parents take sheets home to wash weekly and send extras to change bedding through out the week. Per teacher, facility also has extras to provide to child if needed.

At approximately 9:45am LPA observed the diaper changing table pad to have a fabric sheet covering the pad. LPA advised that changing pad cannot not have fabric covers due to inability to sanitize properly after each use. LPA observed teacher remove sheet from changing pad. LPA recommended paper roll similar to doctors office. Per teacher, staff utilizes changing pad liners. LPA observed liners and recommended a larger size to be able to cover more of the padding. Changing table is within arms reach of the sink. There is at least one sink for every 15 children and 3 working toilets. LPA observed that there is no food preparation as the parents send all snacks and lunch for their children. LPA verified that there is back up snacks for children who need the extra food.

Licensing staff observed all required forms/publications to be posted by the front entrance. Per teacher, parents bring children’s food and bottles from home. Children’s food and bottles are labeled with individual names. All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair. Trash cans used to discard food have tight fitting lids. The facility was observed to be free of flies, other insects, and rodents.

Licensing staff observed 3A30BC fire extinguishers indicating fully charged and last serviced on 10/3/2023 on service tag. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. Facility has a functioning carbon monoxide and smoke detector that meets statutory requirements. Director stated there are no weapons, firearms, or bodies of water on the premises. The last Disaster drill was conducted in 5/14/24. LPA advised that disaster drills must be conducted at least every 6 months. A deficiency is being issued, see page LIC809D.

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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025
LIC809 (FAS) - (06/04)
Page: 2 of 8
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: KIDSZONE PRESCHOOL ACADEMY
FACILITY NUMBER: 198020175
VISIT DATE: 03/11/2025
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At 10:30am licensing staff observed the outdoor play area. Play yard is assessable through preschool classroom. Children exit prek class, walk down a ramp into back lot and walk through preschool play yard to get to the infant and toddler play space. Infants are brought out by a wagon and walking infants walk out. LPA observed an broken gate on ramp that leads to hazards for toddlers and infants and advised teaching staff to lock gate somehow and restrict access. The surface area of the play area and equipment was observed to be in safe conditions. LPA observed trash along the wall from the church parking lot trapped between wall and fence and advised for staff to conduct daily cleaning and removing trash before children begin play. Drinking water is brought outside when children go out.

4 month old infant was observed to be sleeping on his tummy in crib on the walk back from the play yard. LPA advised all staff that all children need to be placed to sleep on their backs. Child was observed to take a short nap. Child was verified to not be able to roll yet. Safe sleep protocols were reviewed with lead teacher and compliance manager. A technical violation is being issued.

Sign in and out is completed digitally through the Brightwheel app where parents utilize a qr code.

Staff records and children’s records were reviewed. There is at least one person trained in CPR and Pediatric First Aid present during this inspection. Two teachers were missing proof of current immunizations (Mmr and Tdap) A deficiency is being issued, see page LIC809-D.

Incidental Medical Services (IMS) is currently not being provided. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025
LIC809 (FAS) - (06/04)
Page: 3 of 8
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: KIDSZONE PRESCHOOL ACADEMY
FACILITY NUMBER: 198020175
VISIT DATE: 03/11/2025
NARRATIVE
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LPA discussed the safe sleep regulations and discussed the Child Care Licensing Safe Sleep webpage at http://www.cdss.ca.gov/inforescources/child-care-licensing/public-information-and-resoucrces/safe-sleep as an additional resource. LPA also informed applicant/licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at http://www/cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. Sleep logs and sleep plans were reviewed and verified for completion.

Facility 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.

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.

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. For childcare 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). The facility has never conducted food prep since getting licensed so did not conduct lead testing.

Teacher was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.


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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025
LIC809 (FAS) - (06/04)
Page: 4 of 8
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: KIDSZONE PRESCHOOL ACADEMY
FACILITY NUMBER: 198020175
VISIT DATE: 03/11/2025
NARRATIVE
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Based on Licensing staff interview, 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 and safety.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative.



Exit interview conducted, report was reviewed, and appeal rights were given to Lead teacher Jasmin Lugo

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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/11/2025 12:46 PM - It Cannot Be Edited


Created By: Stephanie Li On 03/11/2025 at 12:19 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KIDSZONE PRESCHOOL ACADEMY
FACILITY NUMBER: 198020175

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/11/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101174(d)
Disaster and Mass Casualty Plan
(d) Disaster drills shall be conducted at least every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in facility did not conduct a disaster drill every 6 months,which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/25/2025
Plan of Correction
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Per teacher, they will conduct a disaster drill next week and submit updated log to LPA via email by 3/25/25.
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) 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. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 2 teachers were missing proof of MMR and TDAP immunization records, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/11/2025
Plan of Correction
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Per lead teacher, both teaching staff will make appointments to get updated vaccines and provide records to LPA via email by 4/11/2025.
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:Christina Gabelman
LICENSING EVALUATOR NAME:Stephanie Li
LICENSING EVALUATOR SIGNATURE:
DATE: 03/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/11/2025


LIC809 (FAS) - (06/04)
Page: 6 of 8
Document Has Been Signed on 03/11/2025 12:46 PM - It Cannot Be Edited


Created By: Stephanie Li On 03/11/2025 at 12:19 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KIDSZONE PRESCHOOL ACADEMY
FACILITY NUMBER: 198020175

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/11/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101419.2(a)
Infant Needs and Services Plan
(a) Prior to the infant's first day at the center, the infant care center director or assistant director shall complete a needs and services plan for the infant.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 1 infant child was missing infant needs and service plan in child's file, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/14/2025
Plan of Correction
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Per teacher, they will obtain an updated infant needs and service plan and submit to LPA via email by this Friday 3/14/2025.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Christina Gabelman
LICENSING EVALUATOR NAME:Stephanie Li
LICENSING EVALUATOR SIGNATURE:
DATE: 03/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/11/2025


LIC809 (FAS) - (06/04)
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