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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020471
Report Date: 04/04/2025
Date Signed: 04/04/2025 03:06:16 PM

Document Has Been Signed on 04/04/2025 03:06 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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:ACACIA MONTESSORI SCHOOL COVINA INC.FACILITY NUMBER:
198020471
ADMINISTRATOR/
DIRECTOR:		MILDRED BAUTISTAFACILITY TYPE:
850
ADDRESS:450 W ROWLAND STTELEPHONE:
(626) 966-9356
CITY:COVINASTATE: CAZIP CODE:
91723
CAPACITY: 60TOTAL ENROLLED CHILDREN: 57CENSUS: 40DATE:
04/04/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Director Mildred BautistaTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 04/04/25 licensing Program Analyst (LPA) Mary Silva conducted an unannounced random annual inspection. Upon arrival LPA met with Director Mildred Bautista, to whom the reason for the inspections was explained. LPA was led on a tour of the facility. This is a preschool program which consists of four classrooms, one of which is not currently occupied. Per licensee, there are currently 57 children enrolled in the program. Hours of operation for this facility are Monday-Friday from 6:30am-6:30pm.

Licensing staff observed all required forms/publications to be posted by the front entrance. Snack menus were reviewed to ensure that they are being 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. Facility offers breakfast, lunch and two snacks. Meals are prepared by an outside vendor.

PHYSICAL PLANT: All areas were identified on the Facility Sketch were inspected. The following classrooms were inspected: Room #1 Dragonflies: 13 children and 2 teachers, Room #2 Busy Bees: 14 children and 2 teachers, Room #3 Butterflies: 13 children and 2 teachers and 1 assistant, Room #4 Ladybugs was found to be unoccupied. 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 visual supervision of a teacher during tour.

LPA observed the napping equipment (mats/cots) and bedding were inspected for good condition, appropriate storage, and cleanliness.

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NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Mary Silva
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2025
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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: ACACIA MONTESSORI SCHOOL COVINA INC.
FACILITY NUMBER: 198020471
VISIT DATE: 04/04/2025
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The facility washes the sheets and blankets daily. Storage for children's belongings were inspected. All toilets and washing facilities are in safe and sanitary operating conditions. Facility has two bathrooms, one in the hallway and the other in the butterflies classroom.

First Aid supplies are available and complete. Drinking water was readily available indoors. Children have individual sports bottle with their name. Facility provides water from vendor Sparkletts via water dispenser.

At this time, the office is used as an isolation area, there is a cot available for an ill child to rest and the staff restroom will be used if needed.

Licensing staff observed disinfectants, cleaning solutions, and other items that are dangerous to children, were in a cabinet above the sink and made inaccessible to children. Classroom furniture and equipment are in good condition, free of sharp, loose, or pointed parts. Kitchen was observed to be clean and safe. 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 the valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 02/27/2025, as indicated 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 states there are no weapons, firearms, or bodies of water on the premises.

OUTDOORS: At 8:55am, licensing staff observed two outdoor play areas. The first outdoor playground is behind the facility, the equipment is in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained free of hazards. All areas around or under high climbing equipment, swings, slides, and similar equipment are cushioned with material that absorbs a fall.

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NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Mary Silva
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2025
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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: ACACIA MONTESSORI SCHOOL COVINA INC.
FACILITY NUMBER: 198020471
VISIT DATE: 04/04/2025
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LPA observed tricycles to be in good condition. There is adequate shade in the play yard. LPA observed sandbox not in use and covered. The second outdoor area for younger children it is adjacent to the first play area. The surface of the outdoor activity space is maintained free of hazards. There were adequate material and toys for children in care. Drinking water is readily available outdoors.

FACILITY RECORDS: Sign in and out sheets were reviewed to ensure that the person who signs the child in and out uses their full legal signature and records the time of the day. Facility utilizes an electronic device called Care Connect to track attendance.

Disaster drills have been conducted at least every six months. There is at least one person trained in CPR and Pediatric First Aid present during this inspection. Licensing staff also reviewed staff records. The review of Staff records was documented on the LIC 859. Staff present had proof of the AB 1207 Mandated Reporter Training certificate on file. Staff present had proof against TB, measles, pertussis, and influenza. Children’s Records were reviewed for completeness; Inspection of required forms was made and documented on the LIC 857.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are 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.

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NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Mary Silva
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2025
LIC809 (FAS) - (06/04)
Page: 5 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: ACACIA MONTESSORI SCHOOL COVINA INC.
FACILITY NUMBER: 198020471
VISIT DATE: 04/04/2025
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 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). Facility tested water outlets for lead contamination in January 2023.

Director 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 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.

Director 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.

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.

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 was conducted with Director Mildred Bautista, report and appeal rights were given.

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NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Mary Silva
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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