<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371646
Report Date: 10/09/2025
Date Signed: 10/09/2025 12:22:42 PM

Document Has Been Signed on 10/09/2025 12:22 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:CENTRALIA-STATE PRESCHOOL AT (RAYMOND TEMPLE)FACILITY NUMBER:
304371646
ADMINISTRATOR/
DIRECTOR:		ESTRADA, SUSANFACILITY TYPE:
850
ADDRESS:7800 HOLDER STREETTELEPHONE:
(714) 228-3153
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 20DATE:
10/09/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Erika Favela (School Readness Family Liaision) TIME VISIT/
INSPECTION COMPLETED:
12:30 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 10/9/25, Licensing Program Analyst (LPA) Vivian Trinh conducted an on-site inspection for the purpose of an Annual Inspection. LPA and the school representative Vanassa Hidalgo tour the LPA around the facility inside and outside, and the floor and yard plan (LIC 999) were verified. Census was taken in individual classrooms. Erika Favela (School Readiness Family Liaison) stated they are in 2 school sessions with a total capacity of 20 children per session ages 3-5 years old. The operational hours are from Monday - Friday 8:15am-11:15am and 12:00 noon-3:00 pm. The overall census observed was 20 preschool children and 4 staff members in the classrooms. Around 10:05am Erika Favela (School Readiness Family Liaison) arrival to assist the LPA. Around 10:25 am Sheyla Goldberg (Child development account technician) arrives assisting the LPA. During the inspection, it was determined the facility is operating within its licensed capacity and in compliance with staff-to-child ratios.

INDOOR INSPECTION. The LPA inspected the indoor areas and areas accessible to children at the time of the visit. The facility was equipped with working carbon monoxide and smoke detectors, working telephone service, and at least one fire extinguisher that meets statutory and State ire Marshall standards. A record review shows that the last drill was documented on 9/26/25. The Erika Favela (School Readiness Family Liaison) stated that there are no firearms and/or other dangerous weapons in the facility; none were observed during the inspection. Detergents, cleaning compounds, medicines, and other items that could pose a danger if readily available were inaccessible to children in care. At 9:30am, during the inspection reviews, and interview. LPA observed Lysol’s wipes, under need the children’s sink, children were present, one of the staff members is stop a child to open the cabinet when the child attempted, which posed a potential health, safety, or personal rights risk to persons in care. The facility provides age-appropriate toys, play equipment, and materials for the children served.


Continued Page 2.
NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Vivian Trinh
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/09/2025
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 6
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)
Page: 2 of 6
Document Has Been Signed on 10/09/2025 12:22 PM - It Cannot Be Edited


Created By: Vivian Trinh On 10/09/2025 at 11:25 AM
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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: CENTRALIA-STATE PRESCHOOL AT (RAYMOND TEMPLE)
FACILITY NUMBER: 304371646

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/09/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238(g)
Buildings and Grounds
(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, and record review, The licensee did not comply with the section cited above. At 9:30am, during the inspection reviews, and interview. LPA observed Lysol’s wipes, under need the children’s sink, one of the staff members is stop a child to open the cabinet, when the child attempted, which posed a potential health, safety, or personal rights risk to persons in care.
POC Due Date: 10/17/2025
Plan of Correction
1
2
3
4
The Erika Favela (School Readiness Family Liaison) stated that they will conduct a meeting with all staff members to discuss a better solution. An email with the meeting minutes, signed by staff, will be sent to the LPA by the due.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nguyen K Tran
NAME OF LICENSING PROGRAM MANAGER:
Vivian Trinh
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/09/2025


LIC809 (FAS) - (06/04)
Page: 3 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: CENTRALIA-STATE PRESCHOOL AT (RAYMOND TEMPLE)
FACILITY NUMBER: 304371646
VISIT DATE: 10/09/2025
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
26
27
28
29
30
31
32
Page 2.
ON-SITE FOOD PREPARATION: Breakfast will be provided for session 1 and lunch provided for session 2. Lunch will be transported to school from Raymond Temple Elementary school and kept in Kitchen located in the multi-Purpose Room prior to serving food. Drinking water is available to children indoors and children bring their own water bottles from home with child’s name on it and each classroom has a water portable water filtered dispenser. The LPA observed that the facility’s floors, equipment, furniture, and children’s bathrooms were clean, in good repair, and free of sharp edges. The facility meets all posting requirements.

OUTDOOR INSPECTION. The LPA inspected the outdoor areas. The playground was enclosed by a fence at least four feet in height and is in good repair. At the time of inspection, the surface of the outdoor activity area was maintained and free of any observable hazards. The areas around and under high climbing equipment, swings, slides, and other similar equipment were cushioned with material that absorbs falls. The outdoor equipment and toys are in good repair and free of sharp edges. There is drinking water available to children indoors by sport bottle with children’s name or portable water filtered dispenser. There are no bodies of water present at the facility. The outdoor facilities inspected are safe, sanitary and in good repair. The outdoor activity space was inspected for compliance. The playground was enclosed by a fence at least four feet in height. The surface of the outdoor activity space was well maintained and free of hazards. The cushioning material rubber mats are commercially produced for the purpose around the climbing equipment, and slides.

PERSONNEL RECORDS. Staff files were reviewed for staff present during the facility inspection on this date, 4 out of 4 staff members files were reviewed. Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, a person shall not be employed or volunteer at a child day care center if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis, measles for staff members were reviewed and within compliance. Beginning March 31, 2018, H&S Code 1596.8662 requires all directors and employees to complete mandated reporting training and to renew the training every two years. Staff files were reviewed for compliance. At least one staff member present has current EMSA-approved Pediatric CPR/First Aid 11/27/2026 certifications.

CHILDREN’S RECORDS: Children's records were reviewed for compliance present during the facility inspection on this date, 5 out of 5 children files were reviewed Each child has a separate, complete, and current record. Sign in/out procedure was reviewed for compliance. Transportation is not offered to children.

Continued Page 3.

NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Vivian Trinh
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: CENTRALIA-STATE PRESCHOOL AT (RAYMOND TEMPLE)
FACILITY NUMBER: 304371646
VISIT DATE: 10/09/2025
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
26
27
28
29
30
31
32
page 3.
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication, and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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 are available at: https://www.ada.gov/resources/child-carecenters/.

Erika Favela (School Readiness Family Liaison) informed that Licensing Quarterly Updates are available at www.cdss.ca.gov. Erika Favela (School Readiness Family Liaison) may request to be added to an email list to receive a Quarterly Update by contacting the Child Care Advocate at childcareadvocatesprogram@dss.ca.gov or at www.cdss.ca.gov

LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

Information on the additional nutrition training, immunization requirements for children, and Health Schools Act (http://www.cdpr.ca.gov/docs/pestmgt/schoolipm.htm) were provided. Erika Favela (School Readiness Family Liaison) was informed, and website given, about the California Child Care Disaster Plan has been posted to the UCSF California Childcare Health Program website: cchp.ucsf.edu/content/disaster-preparedness Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org A copy of the California Department of Social Services Lead Information Brochure was explained and provided to the facility representative.

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 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). LPA verified that the lead testing was completed in accordance with the Written Directives outlined in PIN 21-21.1-CCP. The childcare center is located in a building that was constructed and built in June 2023.

Continued Page 4

NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Vivian Trinh
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: CENTRALIA-STATE PRESCHOOL AT (RAYMOND TEMPLE)
FACILITY NUMBER: 304371646
VISIT DATE: 10/09/2025
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
26
27
28
29
30
31
32
page 4.

CRIMINAL RECORD CLEARANCE: Erika Favela (School Readiness Family Liaison) understands that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to the initial presence in a licensed childcare facility. Violation of this requirement will result in a citation of a deficiency and civil penalties of one hundred dollars ($100) per violation per day for a maximum of five (5) days. Subsequent violations within a twelve (12) month period will result in a civil penalty of one hundred dollars ($100) per violation per day for a maximum of thirty (30) days in accordance with Section 1596.871 of the Health and Safety Code.

Based on LPA review, the facility was not in compliance and is being cited in accordance with the Health and Safety Code; for the following violations: CCR 101238(g) Buildings and Grounds on the attached LIC 809D.

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 tools, please send them by email 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.

Appeal Rights and deficiencies were discussed. Erika Favela (School Readiness Family Liaison) was provided with a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt for these rights. A notice of site visit was given and must remain posted for 30 days. Exit interview was conducted and the report was reviewed with the director.

End of the Report.

NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Vivian Trinh
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
LIC809 (FAS) - (06/04)
Page: 6 of 6