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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020176
Report Date: 05/05/2026
Date Signed: 05/05/2026 02:30:08 PM

Document Has Been Signed on 05/05/2026 02:30 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:KIDSZONE PRESCHOOL ACADEMYFACILITY NUMBER:
198020176
ADMINISTRATOR/
DIRECTOR:		YVONNE WITHERSFACILITY TYPE:
850
ADDRESS:1206 LINCOLN AVETELEPHONE:
(626) 345-5922
CITY:PASADENASTATE: CAZIP CODE:
91103
CAPACITY: 33TOTAL ENROLLED CHILDREN: 27CENSUS: 24DATE:
05/05/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:Jasmin Lugo, TeacherTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On May 5, 2026, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced Annual/Random inspection at the above facility. LPA met with Teacher, Jasmin Lugo who guided LPA on a tour of the facility. This is a preschool age program that operates Monday to Friday from 7AM to 6PM. During the inspection, LPA observed 24 children in care with 2 staff members. Per Teacher there are 27 children enrolled. LPA conducted a file review on the facility and observed that the director has not been present during a licensing visit for the past 3 years. LPA informed teacher that the director must be present at all times.

The following classrooms were inspected: Blue Classroom: 9 children with 1 staff and Great Room: 15 children with 1 staff. Teacher-child ratios were observed to not be in accordance with Title 22 Regulations. Staff names were recorded. LPA informed Teacher that the Great Room is over ratio and Teacher immediately walked 3 children over to the blue room; making the 2 classrooms 12 children with 1 staff . Per Teacher, the isolation area for children is located in office. At 11:20am, LPA observed S1 in the restroom with 1 child while the remainder for their class was sitting in the chairs in the hallway. Per S1, when there is no assistance the children are left in the hallway without supervision as S1 is changing diapers/assisting the children in the restroom.

The classroom furniture and equipment was inspected for good repair, free of sharp, loose, or pointed parts. All indoor classrooms were inspected to ensure that the floors have a surface that is safe and clean.
NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Monique Jessica Ayala
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/05/2026
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 13
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: KIDSZONE PRESCHOOL ACADEMY
FACILITY NUMBER: 198020176
VISIT DATE: 05/05/2026
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All toilets and washing facilities are in safe and sanitary operating conditions. All materials and surfaces accessible to children are toxic free. LPA observed napping equipment in cots. Napping equipment provided are cots/mats/cribs. Per director, blankets and sheets are sent home weekly.

The facility provides emergency snacks for children and water. The facility does not have a snack menu as snacks are not provided daily.

LPA observed that there are functioning smoke and carbon detectors in the facility. LPA observed a fully charged and serviced fire extinguisher. Emergency disaster drill was last conducted on 05/22/25.

The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All areas around or under high climbing equipment, swings, slides, and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard. LPA observed a bench on the yard that is not in good repair, side of the bench are loose exposing the edges of the paneling and the paint is chipped. This is a potential safety issue as children may be exposed to injury. LPA also observed the bikes to not have the rubber on the handles exposing the open metal area. LPA observed the yard to have trash and debris.



The facility utilizes Brightwheel App to sign in and out sheet. LPA reviewed staff records, staff files were not complete. S2 and S3 are missing documents.

Children’s Records were reviewed to ensure that Identification and Emergency form and a medical assessment are on file. Verification of CPR/First Aid and health preventative practices documentation was reviewed. SB792 (Immunization Requirements for Staff and Employees) was discussed with the teacher. The teacher and staff do currently have immunization documentation.

AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018 any person who works in a child care facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers.

NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Monique Jessica Ayala
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026
LIC809 (FAS) - (06/04)
Page: 3 of 13
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: KIDSZONE PRESCHOOL ACADEMY
FACILITY NUMBER: 198020176
VISIT DATE: 05/05/2026
NARRATIVE
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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/.

CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES: 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. LPA referred licensee [or facility representative] to the Department website for lead: Lead Toxicity Prevention and Water Testing Information (https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information)

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



Teacher 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.

Teacher 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.

NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Monique Jessica Ayala
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026
LIC809 (FAS) - (06/04)
Page: 4 of 13
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: KIDSZONE PRESCHOOL ACADEMY
FACILITY NUMBER: 198020176
VISIT DATE: 05/05/2026
NARRATIVE
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During the exit interview, the teacher, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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.

The facility is being cited a Type A citation for Teacher-Child Ratios. The facility was previously cited a Type A for the same regulation. The facility is also be issued civil penalties for a repeat violation within a 12 month period.

The facility is being cited 11 Type B citations in accordance with Title 22 Regulations. See LIC809D for all citations.

LPA Monique Ayala informed teacher, Jasmin Lugo that this report dated 05/05/2026 document(s)1 1 Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.



Also, LPA Monique Ayala informed the teacher to provide a copy of this licensing report dated 05/05/2026 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification
A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the teacher, Jasmin Lugo. LPA has referred the facility to TSP.
NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Monique Jessica Ayala
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026
LIC809 (FAS) - (06/04)
Page: 5 of 13
Document Has Been Signed on 05/05/2026 02:30 PM - It Cannot Be Edited


Created By: Monique Jessica Ayala On 05/05/2026 at 11:38 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KIDSZONE PRESCHOOL ACADEMY
FACILITY NUMBER: 198020176

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/05/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101216.3(a)
Teacher-Child Ratio
(a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance, except as specified in (b) and (c) below.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on observation, the licensee did not comply with the section cited above, LPA observed 15 children with 1 staff in the Great Room which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/05/2026
Plan of Correction
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4
Teacher, Jasmin Lugo took 3 children from the great into the Blue room to ensure ratios were in compliance.
Section Cited
Deficient Practice Statement
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3
4
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.
Ana Chico
NAME OF LICENSING PROGRAM MANAGER:
Monique Jessica Ayala
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/05/2026


LIC809 (FAS) - (06/04)
Page: 6 of 13
Document Has Been Signed on 05/05/2026 02:30 PM - It Cannot Be Edited


Created By: Monique Jessica Ayala On 05/05/2026 at 11:38 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KIDSZONE PRESCHOOL ACADEMY
FACILITY NUMBER: 198020176

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/05/2026

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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2
3
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Based on record review, the licensee did not comply with the section cited above in the facility has not conducted a disaster drill since 05/2025 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/08/2026
Plan of Correction
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3
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Facility will conduct a disaster drill by POC date (05/08/2026).
Type B
Section Cited
CCR
101238.2(d)(1)
Outdoor Activity Space
(d) The surface of the outdoor activity space shall be maintained: (1) In a safe condition for the activities planned.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on observation, the licensee did not comply with the section cited above in LPA observed a wooden bench where the sides are loose and the paint in chipped. LPA also observed bikes without rubber handles which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/15/2026
Plan of Correction
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Facility will remove bench and order rubber handles for the bikes by POC date (05/15/2026)
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ana Chico
NAME OF LICENSING PROGRAM MANAGER:
Monique Jessica Ayala
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/05/2026


LIC809 (FAS) - (06/04)
Page: 7 of 13
Document Has Been Signed on 05/05/2026 02:30 PM - It Cannot Be Edited


Created By: Monique Jessica Ayala On 05/05/2026 at 11:38 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KIDSZONE PRESCHOOL ACADEMY
FACILITY NUMBER: 198020176

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/05/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238.2(d)(2)
Outdoor Activity Space
(d) The surface of the outdoor activity space shall be maintained: (2) Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above LPA observed trash, debris and spiderwebs on outdoor yard and equipement which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/11/2026
Plan of Correction
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Facility will have outdoor area clean and free of trash, debris and spiderwebs by POC date (05/11/2026)
Type B
Section Cited
CCR
101229(a)(1)
Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview the licensee did not comply with the section cited above LPA observed children sitting in the hallway near the restroom alone. LPA spoke with S1 who stated when there is no assistance, children are left unsupervised while they assist the children in the restroom which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/06/2026
Plan of Correction
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Facility will ensure children are supervised at all times.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ana Chico
NAME OF LICENSING PROGRAM MANAGER:
Monique Jessica Ayala
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/05/2026


LIC809 (FAS) - (06/04)
Page: 8 of 13
Document Has Been Signed on 05/05/2026 02:30 PM - It Cannot Be Edited


Created By: Monique Jessica Ayala On 05/05/2026 at 11:38 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KIDSZONE PRESCHOOL ACADEMY
FACILITY NUMBER: 198020176

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/05/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in LPA observed S2 and S3 did not have a current mandated reporter training which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/15/2026
Plan of Correction
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2
3
4
S2 and S3 will compelte their training by POC date (05/15/2026)
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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2
3
4
Based on observation, the licensee did not comply with the section cited above in LPA observed S2 and S3 did not have immunization records in their files which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/22/2026
Plan of Correction
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2
3
4
S2 and S3 will place a copy of their immunizations in their files by POC date (05/22/2026)
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ana Chico
NAME OF LICENSING PROGRAM MANAGER:
Monique Jessica Ayala
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/05/2026


LIC809 (FAS) - (06/04)
Page: 9 of 13
Document Has Been Signed on 05/05/2026 02:30 PM - It Cannot Be Edited


Created By: Monique Jessica Ayala On 05/05/2026 at 11:38 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KIDSZONE PRESCHOOL ACADEMY
FACILITY NUMBER: 198020176

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/05/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101215.1(d)
Child Care Center Director Qualifications and Duties
(d) The child care center director, or the substitute director as specified in (f) below, shall be on the premises during the hours the center is in operation.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and record review the licensee did not comply with the section cited above in director has not been present at the facility in the past three years when the department is conducting and inspection which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/08/2026
Plan of Correction
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2
3
4
Director will submit their weekly schedule for the month to LPA by POC date (05/08/2026) to ensure there is a director on site at all times.
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review the licensee did not comply with the section cited above S2 does not have a current health screening which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/05/2026
Plan of Correction
1
2
3
4
S2 will complete their heallth screening by POC date (06/05/2026)
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ana Chico
NAME OF LICENSING PROGRAM MANAGER:
Monique Jessica Ayala
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/05/2026


LIC809 (FAS) - (06/04)
Page: 10 of 13
Document Has Been Signed on 05/05/2026 02:30 PM - It Cannot Be Edited


Created By: Monique Jessica Ayala On 05/05/2026 at 11:38 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KIDSZONE PRESCHOOL ACADEMY
FACILITY NUMBER: 198020176

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/05/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(l)(1)(B)
Personnel Requirements
(B) A copy of the signed LIC 9052 (11/94) shall be kept in the employee's personnel record.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in S2 does not have a signed LIC9052 on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/08/2026
Plan of Correction
1
2
3
4
S2 will sign LIC9052 by POC date (05/08/2026)
Type B
Section Cited
CCR
101216.1(c)(1)
Teacher Qualifications and Duties
(c) To be a fully qualified teacher, a teacher shall have one of the following: (1) Twelve postsecondary semester or equivalent quarter units in early childhood education or child development completed, with passing grades, at an accredited or approved college or university; and at least six months of work experience in a licensed child care center or comparable group child care program.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above S3 does not have a copy of their transcripts in their file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/15/2026
Plan of Correction
1
2
3
4
S3 will obtain a copy of their transcripts and place in their file by POC date (05/15/2026)
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ana Chico
NAME OF LICENSING PROGRAM MANAGER:
Monique Jessica Ayala
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/05/2026


LIC809 (FAS) - (06/04)
Page: 11 of 13
Document Has Been Signed on 05/05/2026 02:30 PM - It Cannot Be Edited


Created By: Monique Jessica Ayala On 05/05/2026 at 11:38 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KIDSZONE PRESCHOOL ACADEMY
FACILITY NUMBER: 198020176

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/05/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101217(a)(12)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (12) Tuberculosis test documents as specified in Section 101216(g).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above S2 does not have TB test in their file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/05/2026
Plan of Correction
1
2
3
4
S2 wll complete their TB test by POC date (06/05/2026).
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ana Chico
NAME OF LICENSING PROGRAM MANAGER:
Monique Jessica Ayala
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/05/2026


LIC809 (FAS) - (06/04)
Page: 12 of 13