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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020291
Report Date: 08/01/2025
Date Signed: 08/01/2025 01:03:04 PM

Document Has Been Signed on 08/01/2025 01:03 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:MADISON CHILD DEVELOPMENT CENTERFACILITY NUMBER:
198020291
ADMINISTRATOR/
DIRECTOR:		KYM ALLENFACILITY TYPE:
830
ADDRESS:1351 S. MAIN STTELEPHONE:
(909) 622-9805
CITY:POMONASTATE: CAZIP CODE:
91766
CAPACITY: 16TOTAL ENROLLED CHILDREN: 16CENSUS: DATE:
08/01/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
01:10 PM
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Licensing Program Analyst (LPA) Kamile Martin and Joanne Solario Campos, conducted an unannounced annual site inspection, on this date. This inspection is to ensure the health and safety standards as required by the regulations governing child care centers are met. LPA ‘s met with Kym Allen and co teachers Heather and Samanth. The facility is an infant center with toddler component. Infant classroom operates out of Room 5 and toddler classroom out of Room 7. On site there is also a preschool program. Per teachers there are currently 8 infants and 8 toddlers enrolled. There were 3 infants, 5 toddlers, and 5 staff present during the inspection. This Early Head Start program runs for 12 months. A copy of the Entrance Checklist for Child Care Centers form (LIC 125) was provided. The facility operates Monday-Friday7:30 AM 3:15PM.

All areas identified on the facility sketch were identified. LPA ‘s began the tour of the facility with Kym Allen, The facility consists of 2 classrooms in Rm 5 infants and Rm 7 toddlers. The one large outdoor play area with a separate gated playground for the older toddlers.

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. LPA’s observed the sign in /out sheets at the front entrance of the classrooms. Teacher stated the ill/isolation area is located in the office area.

NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Kamile Martin
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2025
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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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: MADISON CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 198020291
VISIT DATE: 08/01/2025
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LPA ‘s toured classrooms and observed, age appropriate fixtures, furniture, equipment and supplies. Toys and play equipment were also observed to be age appropriate clean and safe. All surfaces and materials accessible to children, including toys, are toxic free. LPA ‘s observed the facility has central heat and air, overhead lights as well as natural light. LPA’s observed all restrooms used by children to be inoperable condition, supplied with paper towels, soap and toilet paper. All were inspected for safety, sanitation. LPA’s observed changing table within arms reach of a sink for both classrooms.

Cribs were observed to be free of loose items. Cots were available for infants who are able to climb out of crib. Sleeping area is physically separated and cribs do not limit staff’s ability to watch infants at all times. Napping cots were observed with individual tight fitted sheets. Teachers stated they have a third party laundry service.

The facility has pitchers of filtered water with cups for children to drink freely. The facility provides breakfast, lunch, and PM snack, menus were observed posted on the refrigerator and license board. All food is made and provided by the school district daily. LPA’S observed the food preparation area to be clean and free of litter, rubbish, rodents and or any other vermin. And storage containers for solid waste including movable bins with tight fitting covers that are kept on. The facility was observed to be free of flies, other insects and rodents.

Carbon monoxide and smoke detectors were observed and were not tested due to the detectors being wired to the emergency pull down fire alarm system. Fire extinguisher type 2A-10BC (Service date2/19/25 ) must be serviced annually.

Fire and earthquake drills must be conducted every 6 months and documented. Last emergency drill was conducted on 07/14/2025. Hazardous items including disinfectants, poisonous, cleaning solutions and any other items that could pose a danger to children were observed to be stored inaccessible to children.

Licensing staff was then guided to the outdoor play area. Children will use pitchers of filtered water with cups to drink freely while outdoors. LPA’s observed age appropriate outdoor toys, play equipment and materials to be clean, and safe for children’s use. There was adequate shade available by use of the building, canopy and trees. All areas around play equipment and slides are cushioned with material to absorb a fall. No bodies of water were observed on the premise.

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

DATE: 08/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2025
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: MADISON CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 198020291
VISIT DATE: 08/01/2025
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LPA observed medication was stored and made inaccessible to children. First aid supplies were observed to have the required items such as a thermometer, scissors, and twizeers. There is a fully equipped first aid kit available in each classroom.

Staff 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.

Children’s Records, rooster, sleep logs, and staff files were reviewed and were found to be complete. LPA ‘s observed during staff file review, that there is at least one person present on this date and at all times, with Pediatric CPR & First Aid. LPA’s observed Teacher Samantha Schneider has pediatriac First aid/CPR certification from American Heart Association and expires 8/2/27 and has proof of immunization against pertussis, MMR and Influenza declination. Teacher has completed the mandated reporter AB1207 training and it expires 8/17/25 . Teacher was advised that the mandated reporter training must be completed every 2 years and is available at www.mandatedreporterca.com.

Lead Testing: 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 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 outlined in PIN 21-21,1-CCP. LPA referred licensee to the Department website for lead: Lead Toxicity Prevention and water Testing Information.

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

DATE: 08/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2025
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: MADISON CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 198020291
VISIT DATE: 08/01/2025
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Per teacher they have one child receiving medication and has an IMS plan on file. Medication was observed to be stored and labeled properly. For IMS information see PIN 22-02- CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/resources/child-care-centers/.

LPA’s discussed the safe sleep regulations with teaching staff and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA’s also informed admin the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Teachers were 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.

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 completed lead testing and have no lead exceedances.

Licensee, 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&R) throughout California.

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

DATE: 08/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2025
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: MADISON CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 198020291
VISIT DATE: 08/01/2025
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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.

To improve the quality and value of the new inspection process, a survey will 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/process.

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

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there were no deficiencies cited during today's Inspection.

Exit interview conducted and report was reviewed with teacher Heather appeal rights were provided.

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

DATE: 08/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2025
LIC809 (FAS) - (06/04)
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