198401217-5-1-2025-54-CC-ECHZ-DG9T48-20250501142330

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198401217
Report Date: 05/01/2025
Date Signed: 05/01/2025 02:23:50 PM

Document Has Been Signed on 05/01/2025 02:23 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:	MARY CAROL ACADEMY		FACILITY NUMBER:	198401217
ADMINISTRATOR/ DIRECTOR:	JACKSON, NATASHA		FACILITY TYPE:	860
ADDRESS:	3435 SAN ANSELINE AVENUE		TELEPHONE:	(562) 230-3112
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90808
CAPACITY: 60	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	05/01/2025
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:30 AM
MET WITH:	Natasha Jackson		TIME VISIT/ INSPECTION COMPLETED:	02:40 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On May 01, 2025, at 9:30 AM, Licensing Program Analysts (LPAs), Elka Chavez and Jeanette Estrada conducted an announced Pre-Licensing inspection for a new license. Upon arrival LPAs met with Applicant Representative, Natasha Jackson. Also present was Lance Riley. Applicant is requesting to be licensed for (60) preschoolers 3 to 5 years old in (1) classroom. Hours of operation will be Monday to Friday from 6:30 AM to 6:00 PM. All indoor and outdoor activity space utilized for the children was inspected today. LPAs informed Natasha Jackson that staff are required to maintain direct visual supervision of the children at all times during indoor and outdoor activities. When medications are on site, Natasha Jackson stated that they will be in a locked box in the director’s office. A fully equipped first aid kit is located in the classroom. There is an operational carbon monoxide detector on site located in the classroom. All required licensing documents were observed posted in the classroom. Children will be signed in and out in the classroom. LPAs continued to tour the facility and measured all indoor and outdoor activity space. LPAs observed the classroom to be an open concept room. LPAs advised to have extra care and supervision in the activity areas. Total indoor activity space measured 2,123.47 square feet, which is sufficient to accommodate the requested overall capacity of (60) Children. LPAs observed all indoor activity space to be complete with safe, age-appropriate furniture and equipment, including tables, chairs, cubbies, napping cots, bookshelves, and other activity supplies for the children. Drinking water is available in the classrooms via water jugs and disposable cups. LPAs observed all hazardous items to be inaccessible to children. There are no bodies of water or weapons on the property. Fire clearance was granted on 04/14/2025. Page 1

NAME OF LICENSING PROGRAM MANAGER: Monica Cuddy
NAME OF LICENSING PROGRAM ANALYST: Elka Chavez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/01/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025

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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MARY CAROL ACADEMY	FACILITY NUMBER: 198401217
	VISIT DATE: 05/01/2025

NARRATIVE

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LPAs observed a total of (6) sinks, (1) urinal and (5) toilets available for children’s use. These are sufficient to accommodate the requested overall capacity of (60) children. There is a separate staff restroom equipped with a toilet and a sink next to the banquet room. The isolation area for children who are ill will be the director’s office. The ill children will use the restroom located next to the classroom.

Facility will provide breakfast, lunch and PM snacks. The kitchen area currently includes an industrial stove, industrial sink, microwave and refrigerator. The kitchen area and food storage areas were observed to be free of rodents and/or vermin. Food was observed to be properly stored separate from cleaning materials. Hazardous items in kitchen are inaccessible to children via a locked door.

The facility currently has a fully fenced playground area. Fencing is chain link and is at least four feet high. The total square footage for all the outdoor activity space for the preschool is 6, 934.80 square feet, which is sufficient to accommodate the requested capacity. Shade is provided via shade structure. There are sufficient outdoor age-appropriate toys and play equipment available on the playground. There is a climbing dome on the playground for children ages 3 to 9 which is properly anchored. LPAs observed adequate cushioning in fall zones of the climber. LPAs also observed 2 teeter totters in the playground for children ages 3 to 12. Per Applicant representative, Natasha Jackson there is a plan of supervision in place which includes following the manufacturer’s instructions. LPAs observed the play equipment is at least 6 feet away from any structure per the manufacturer’s instructions. LPAs observed the chain link fence facing San Anseline Ave. next to the grass area had gaps and missing parts. Applicant representative stated that the grass area will be made off limits to children and a fence will be installed. Drinking water is available via water jug filled with bottled water and disposable cups. Applicant representative, Natasha Jackson was reminded that any changes to the facility must be reported to and approved by Community Care Licensing.
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).

Applicant representative, Natasha Jackson was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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
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NAME OF LICENSING PROGRAM MANAGER: Monica Cuddy
NAME OF LICENSING PROGRAM ANALYST: Elka Chavez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/01/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025

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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MARY CAROL ACADEMY	FACILITY NUMBER: 198401217
	VISIT DATE: 05/01/2025

NARRATIVE

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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.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A 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, available at: http://www.ada.gov/childqanda.htm

LPAs reviewed with Applicant representative, Natasha Jackson the LIC 311A, Records to Be Maintained at The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

Applicant representative, Natasha Jackson was informed of the MyChildCarePlan.org site, 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.

Exit interview conducted and report was reviewed with the Applicant representative, Natasha Jackson.

The following corrections are needed prior to the issuance of the license:

• The Applicant will need to make the grass area in the outdoor space inaccessible to children in care.

Applicant Representative, Natasha Jackson understands that all proof of corrections must be provided to the Department within 30 days, or the application may be denied.

Upon a final file review,, a license for (60) preschool children will be granted.

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NAME OF LICENSING PROGRAM MANAGER: Monica Cuddy
NAME OF LICENSING PROGRAM ANALYST: Elka Chavez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/01/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025

LIC809 (FAS) - (06/04)

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