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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198401159
Report Date: 03/04/2026
Date Signed: 03/04/2026 05:04:39 PM

Document Has Been Signed on 03/04/2026 05:04 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:BETHANY MANOR DEVELOPMENT & LEARNING CENTERFACILITY NUMBER:
198401159
ADMINISTRATOR/
DIRECTOR:		RENEE KOSKAFACILITY TYPE:
860
ADDRESS:12110 E WALNUT STTELEPHONE:
(562) 868-1517
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 64TOTAL ENROLLED CHILDREN: 16CENSUS: 15DATE:
03/04/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Renee KoskaTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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 ANNUAL/ RANDOM INSPECTION CONDUCTED

On March 4, 2026, at 9:35 AM, Licensing Program Analyst (LPA) A. Carter conducted an unannounced Annual Random Inspection and met with Facility representative (FR), Renee Koska. LPA disclosed the purpose of the inspection and was granted entry into the facility. The facility is currently licensed for a capacity of 64. This facility is located on the premises of Cesar Chavez Elementary School. The facility is accessible through the parking lot on Rosecrans Avenue. There is also a head start program with facility# 198015619 on the same premises, operating in rooms 42 and 43. Hours of operation are Monday, Wednesday, and Friday from 9:00 AM to 12:00 PM. LPA was taken on a guided tour of the facility both indoors and outdoors. Required postings were observed near the entrance of classroom 30. Entrance Checklist was provided.

There is a total census of 15 children and 3 teachers present. The facility is made up of 5 classrooms. Teacher-child ratios were observed, and staff names recorded. All center staff present during today’s inspection had fingerprint clearance and are associated to the designated license number. Care and supervision were evaluated to determine if the basic needs of children are met and appropriate. The sign-in and out sheets were reviewed and in compliance. Personal Rights of children were observed by LPA.

Beginning at 9:45 AM, furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting, and ventilation were evaluated. Children’s napping equipment was not observed due to program lasting only 3 hours. Storage for children's belongings, bathrooms facilities, and isolation areas were inspected. The isolation area for children who are ill is the main office, supervised and away from other children in care.


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NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Andrea Carter
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2026
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 5
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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: BETHANY MANOR DEVELOPMENT & LEARNING CENTER
FACILITY NUMBER: 198401159
VISIT DATE: 03/04/2026
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Age-appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, safety, and sanitation. Children have access to the restroom designated for this program located in the main building. LPA observed 3 sinks and 9 stalls available for children’s use. LPA observed bathroom to have operable toilet/sink and adequate toileting supplies for children in care. No hazards observed. LPA observed cubbies with wooden toys, puzzles, books, and other appropriate toys to be clean and free of hazards at time of inspection. LPA observed carpets and age-appropriate tables and chairs in each classroom. LPA observed backpacks for first aid supplies mounted to the wall in each classroom.

At 9:55 AM, outdoor equipment was inspected for safety, cushioning material, good repair, and age-appropriateness. There is a play structure with a slide and adequate shading. Per facility representative, the program mainly uses the Gross Motor Classroom (room 23), for gross motor activities. The children have access to drinking water via bottled water and disposable cups. Play area was inspected for hazards and inaccessibility to bodies of water; no bodies of water or hazards observed at time of inspection.

Menus observed and reviewed at time of inspection. Parents provide snacks for children in care. The facility also has snack items available if needed. Children have their snacks in classroom 30. LPA observed snack items were properly stored. A refrigerator, sink and 2 microwaves were observed by LPA in the classroom. Drinking water is provided via bottled water and disposable cups. LPA confirmed Carbon monoxide and smoke detectors were present and determined to be in operable condition. Fire extinguishers were observed as being serviced on December 26, 2025. Hazardous items including poisonous cleaning compounds were stored inaccessible to children. Disaster drill log observed, with last drill conducted on February 2, 2026, per observation.

At 10:18 AM, staff and children’s records were reviewed. Mandatory forms for the children and staff files were discussed. Inspection of required forms were made and documented on the LIC 857 for children and the LIC 859 for staff. LPA observed current CPR and First Aid Certification for center staff. CPR card expires on 08/25/27 for Staff Member#1. Role and responsibilities of being a Mandated Reporter was reviewed. Facility representative was advised on how to access forms and Regulations online at www.ccld.ca.gov. to ensure the most current information regarding regulations for all those who assists in providing care.
NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Andrea Carter
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2026
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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: BETHANY MANOR DEVELOPMENT & LEARNING CENTER
FACILITY NUMBER: 198401159
VISIT DATE: 03/04/2026
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The following were discussed:
LPA advised of the requirement to report Unusual Incidents and/or injuries to the parent/guardian and to CCL within the time frame specified by the regulation, this includes any changes as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your location.

Facility representative 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.

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 referred 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 discussed the safe sleep regulations with facility representative 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 also informed facility representative of the importance of checking for and removing any 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.
NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Andrea Carter
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2026
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: BETHANY MANOR DEVELOPMENT & LEARNING CENTER
FACILITY NUMBER: 198401159
VISIT DATE: 03/04/2026
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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/.

Facility representative 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.

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 .

No deficiencies will be cited today March 4, 2026. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the facility representative Renee Koska.
Appeal Rights Given



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NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Andrea Carter
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2026
LIC809 (FAS) - (06/04)
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