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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021679
Report Date: 06/25/2026
Date Signed: 06/25/2026 12:34:45 PM

Document Has Been Signed on 06/25/2026 12:34 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:VILLAGE PLAYGARDENFACILITY NUMBER:
198021679
ADMINISTRATOR/
DIRECTOR:		PARTIDA, JASMINEFACILITY TYPE:
860
ADDRESS:240 COLORADO BLVD.TELEPHONE:
(213) 700-9107
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 15DATE:
06/25/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Jasmine Partida - DirectorTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced Case Management inspection for the purpose of following up on an incident reported to the Department on 06/18/2026. Upon arrival at 11am, LPA met with Facility Representative Jasmine Partida, to whom the purpose of the inspection was explained. A tour of the facility was provided and census was taken. There were 15 children with 2 staff members.

On 06/18/2026, Child #1 was sitting on the metal cross bar underneath the play structure, lost balance, and fell off. The fall resulted in an injury that required medical attention. During today's inspection, LPA conducted interviews with two staff members. Pictures of the play structure area were obtained during today's visit. There is a waiver on file for the facility use of the play yard area. Play yard area is to be shared on a staggered schedule, with Barnhart School's TK/Kindergarten.

During interviews, both staff state that children in care use the underneath seat section of the play structure, but do not climb up the structure. Staff #2 states unless they have children 5-6yrs old, they do not go up the structure. LPA confirmed that the structure is made for ages 5-12yrs. Staff #2 states they were on the wood chips watching the children. Child #1 (C1) and a friend were on the underneath section and C1 was sitting on the metal bar section, adjacent to the green seat. Metal bar was observed to be approximately 3ft off the woodchips. Staff #2 helped a different child, and when they turned back, they saw Child #1 had fallen. C1 got up holding their arm and walked over to Staff #2. Staff provided immediate first aid to the child, contacted parents, and documented injury.

Based on prelicensing report from 03/03/2025, per applicant representative Geoff Ramsey-Ray, "staff will ensure that children under the age of 5 will not be allowed on the climbing structure."


REPORT CONTINUES PAGE 1 of 2
NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Nolan Tcheng
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/25/2026
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 4
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: VILLAGE PLAYGARDEN
FACILITY NUMBER: 198021679
VISIT DATE: 06/25/2026
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Based on observation, record review, and interview, facility violated Child #1's personal rights by letting them use the play structure when it is not age appropriate to the children in care. Facility is allowed to use the play yard area but is not allowed to use the play/climbing structure unless that child is at least 5yrs old. This includes the bottom seat section underneath the structure, as it is a part of the structure.

LPA Tcheng informed Facility Representative that this report dated 06/25/2026 documents one Type A citation, which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, and personal rights of children in care.

Also, LPA Tcheng informed the Facility Representative to provide a copy of this licensing report dated 06/25/2026, that documents any Type A citation, to parent/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 (LIC9224), or other written statement, must be placed in the child's file for verification.

The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809D for deficiencies that are being cited and need to be cleared to protect the children’s health & safety.

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

Exit interview conducted and report was reviewed with Facility Representative Jasmine Partida, at 12:40pm. Plan of correction developed and copy of Report provided.

END OF REPORT PAGE 2 of 2

NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Nolan Tcheng
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2026
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 06/25/2026 12:34 PM - It Cannot Be Edited


Created By: Nolan Tcheng On 06/25/2026 at 12:11 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: VILLAGE PLAYGARDEN
FACILITY NUMBER: 198021679

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/25/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/26/2026
Section Cited
CCR
101223(a)(2)

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(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.

This requirement is not met as evidenced by:
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Per Facility Representative, they will created an memo of age appropriate play yard equipment that is allowed to be used by children in care. Staff will sign the form as acknowledgment and understanding of what areas can be used by children under the age of 5yrs old. Will be sent to LPA by POC date.
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Based on interview, record review, and observation, licensee violated Child #1's personal rights by allowing them to use non age appropriate play equipment, resulting in injury needing medical attention. This was an immediate risk to the health, safety, and personal rights of child 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.
Ana Chico
NAME OF LICENSING PROGRAM MANAGER:
Nolan Tcheng
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/25/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/25/2026


LIC809 (FAS) - (06/04)
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