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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197400552
Report Date: 08/21/2025
Date Signed: 08/21/2025 02:51:45 PM

Document Has Been Signed on 08/21/2025 02:51 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:CHILDS FAMILY DAY CAREFACILITY NUMBER:
197400552
ADMINISTRATOR/
DIRECTOR:		WOLITA CHILDSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 638-3062
CITY:COMPTONSTATE: CAZIP CODE:
90222
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 3DATE:
08/21/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:21 AM
MET WITH:Licensee CHILDS, WOLITATIME VISIT/
INSPECTION COMPLETED:
03:05 PM
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On 8/21/25 Licensing Program Analysts (LPA) Tyler Reyes conducted an unannounced Annual/Random inspection at the above facility. LPA met with Licensee Childs, Wolita and provided an Entrance Checklist-Family Child Care homes LIC 126. LPA conducted a tour of the facility led by Licensee Wolita. LPA observed (3) children in care. Per Licensee hours of operation are 6AM-6PM Monday- Friday. The facility is licensed to care for MAXIMUM CAPACITY: 12 CHILDREN, INCLUDING LICENSEE'S CHILDREN UNDER 10 YEARS OF AGE WHO RESIDE IN THE HOME, WITH NO MORE THAN 4 INFANTS. I INFANTS MEANS A CHILD UNDER 2 YEARS OLD). LPA discussed and provided copies of Capacity Regulations for Family Child Care Home License, Personnel Report LIC 500, and Child Care Facility Roster LIC 9040.

During the inspection, the following individuals were present in the home: Licensee and Staff 1 (S1). All adults present in the home have obtained a criminal record clearance or exemption. LPA informed that any individual that has direct contact with the children and resides in the home is required to have a criminal record clearance or exemption.

Facility Sketch: The facility is a one-story home consists of a Front yard, (3) bedrooms, (2) restrooms, daycare room, kitchen, laundry area, enclosed backyard, and detached garage.

On-Limits: Front yard, daycare room, (1) restroom, and an area of backyard.

Off-Limit: (3) bedrooms, kitchen, laundry area, and an area of backyard.

Facility Postings: LPA observed required postings in daycare room: Facility Licensee, PUB 394 Notification of Parents’ Rights, and LIC 9148 Earthquake Preparedness, and LIC 610A Emergency Disaster Plan. LPA discussed the documents to be posted in a prominent, publicly accessible area at facility. LPA informed Licensee to ensure that Department telephone number is visible on PUB 394 Notification of Parents’ Rights.

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Tyler Reyes
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/21/2025
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 10
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 10
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: CHILDS FAMILY DAY CARE
FACILITY NUMBER: 197400552
VISIT DATE: 08/21/2025
NARRATIVE
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Emergency Disaster Drill: Based on record and interview with Licensee last Emergency Disaster Drill was a Fire Drill conducted on October 16, 2024.LPA discussed that the licensee shall conduct fire and disaster drills at least once every six months and must document each drill, including the date and time it was conducted. Documentation of fire and disaster drills must be kept ready for review.

Pediatric CPR/First Aid in Pediatrics Certification: Based on record review and interview with Licensee Wolita's and S1's CPR/First Aid was completed 12/10/2022 from American Red Cross. The missing of a current Pediatric CPR/First Aid poses a potential health and safety risk.

Mandated Training Certificate: Licensee and S1 Completed AB1207 3/13/2025

Transportation: Per Licensee transportation is provided. A valid California Driver License of the licensee was observed with an expiration date of 11/2/2025. California Driver License expires this year and Licensee stated plans to renew prior to expiration.

Infants: LPA observed (1) infant in care napping. LPA discussed infant safe sleep with Licensee. Cribs or play yards shall be free from all loose articles and objects.Facility should supervise infants while they are sleeping adhering to physical checks every (15-minute) and ensuring infants are sleeping on their back. Based on record review and interview with Licensee has not been using a 15-min sleep log to document C1’s sleep. Documentation of these checks shall be maintained in the infant’s file and made available for Department review. Documentation shall include the date, infant’s name, and the time of each (15-minute) check. The infant’s authorized representative and emergency contact shall be notified if any signs of distress or labored breathing are observed. An individual Sleep Plan LIC 9227 shall be completed for each infant up to12 months of age. LPA provided Infant Safe for Family Child Care Homes from California -DSS-Manual -CCL.

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Tyler Reyes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
LIC809 (FAS) - (06/04)
Page: 7 of 10
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: CHILDS FAMILY DAY CARE
FACILITY NUMBER: 197400552
VISIT DATE: 08/21/2025
NARRATIVE
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Items not permitted: LPA provided the Licensee with a picture listing some of the items not permitted in a family childcare home, which include a bouncer, a jumper, and a walker. These items are not allowed to be on the premises of the facility.

Meals: Per Licensee children will have meals in daycare room. Licensee was advised to ensure all food brought from home is properly labeled and stored. Based on record C2 has an allergy to eggs. Per Licensee food alternatives are provided.

Medication: Per Licensee the facility will provide incidental medical services. If required, medication will be inaccessible to children by centrally storing and locking. Medications will be administered in accordance with PIN 22-02-CCP, which outlines requirements for proper storage, documentation, and staff training.

The following on-limit areas that will be used by children were inspected for safety, comfort, and cleanliness. Heating and cooling are provided by ceiling fans. LPA observed age-appropriate toys and learning materials. Telephone service is provided via cell phone. LPA observed a fire extinguisher in the kitchen with no proof of service or purchase which poses a potential health and safety risk. Family Child Care Homes are required to maintain a new or serviced fully charged fire extinguisher which is at least a 2A:10BC annually. LPA observed a fireplace in the daycare room screened. LPA observed a wall heater that was partially protected by a small screen. The protective barrier was not age-appropriate for children in care which poses a potential health risk. LPA observed an operable smoke and carbon monoxide detector in the kitchen. LPA observed electrical outlet covers on the outlets. LPA observed knives on the top kitchen counter. LPA reminded Licensee to ensure all knives are stored in manner that both inaccessible and age-appropriate for children in care. Per Licensee there are no firearms on the premises. If firearms are present, LPA verified per Title 22 regulations that they are locked, with ammunition stored separately.

Poisons/Cleaning Products: Based on observation LPA observed personal hygiene products stored in the unlocked medicine cabinet of the restroom accessible to children. A step stool at the stink granting children access to the cabinet was present. Additional personal hygiene products were also stored in the shower. LPA observed various cleaning products Clorox and insect killer stored in unsecured cabinet in the laundry area. LPA observed sunscreen sprays and a lighter accessible children. These items pose a potential health and safety risk to children in care.

Outdoor: Children may use the front yard and backyard for outdoor play. Per Licensee children will be supervised during outdoor play. Per Licensee they have no animals. No animal feces were observed. LPA discussed and provided copies of PIN 25-06 Extreme Heat Prevention. No pool, spas or other bodies of water.

Page 3 of 5

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Tyler Reyes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
LIC809 (FAS) - (06/04)
Page: 8 of 10
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: CHILDS FAMILY DAY CARE
FACILITY NUMBER: 197400552
VISIT DATE: 08/21/2025
NARRATIVE
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Staff Files: LPA reviewed Licensee and S1 file for the following documentation: LIC 9052 Employee Rights, Immunization Record, and LIC 9108 Statement Acknowledging Requirements to Report Child Abuse, Licensee and S1 had required documentation.

Children Files: LPA reviewed C1-C3 file for the following documentation: LIC 282 Affidavit Regarding Liability Insurance, LIC 700 Identification and Emergency Information, LIC 627 Consent for Emergency Medical Treatment, and LIC 995A Notification of Parents’ Rights. (1) of (3) children had required documentation. C1 was missing proof of immunization and C3 was missing proof of Authorized Representative Signature on form LIC 627 Consent for Emergency Medical Treatment which poses a potential health risk.

LPA discussed reporting requirements and the staff’s responsibilities as a mandated reporter, including the obligation to report to Community Care Licensing and emergency personnel when necessary

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.

Licensee was reminded that all adults 18 and over living or working in the home, 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 licensed Family Child Care Home. 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.

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Tyler Reyes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
LIC809 (FAS) - (06/04)
Page: 9 of 10
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: CHILDS FAMILY DAY CARE
FACILITY NUMBER: 197400552
VISIT DATE: 08/21/2025
NARRATIVE
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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for 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.

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/.

Licensee 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.

During the exit interview, the LICENSEE CHILDS, WOLITA, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. Exit interview conducted and Appeal Rights provided with Licensee CHILDS, WOLITA. Please see attached LIC 809-D for citations.

NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Tyler Reyes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
LIC809 (FAS) - (06/04)
Page: 10 of 10
Document Has Been Signed on 08/21/2025 02:51 PM - It Cannot Be Edited


Created By: Tyler Reyes On 08/21/2025 at 01:37 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CHILDS FAMILY DAY CARE
FACILITY NUMBER: 197400552

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations the licensee did not comply with the section cited above LPA observed a fire extinguisher in the kitchen with no proof of service or purchase which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/04/2025
Plan of Correction
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Licensee will ensure the maintain a new or serviced fire extinguisher annually. Licensee will service fire extinguisher or purchase a fire extinguisher. POC will be cleared by a visit.
Type B
Section Cited
CCR
102417(g)(1)
(1) Fireplaces and open face heaters shall be screened to prevent access by children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above LPA observed a wall heater that was partially protected by a small screen. The protective barrier was not age-appropriate for children in care which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/04/2025
Plan of Correction
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Licensee will ensure open face heater will have an age-appropriate screen for children in care. POC will be cleared by visit.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Karen Chambers
NAME OF LICENSING PROGRAM MANAGER:
Tyler Reyes
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/21/2025


LIC809 (FAS) - (06/04)
Page: 3 of 10
Document Has Been Signed on 08/21/2025 02:51 PM - It Cannot Be Edited


Created By: Tyler Reyes On 08/21/2025 at 01:43 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CHILDS FAMILY DAY CARE
FACILITY NUMBER: 197400552

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
(4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in LPA observed personal hygiene products stored in the unlocked medicine cabinet of the restroom accessible to children. A step stool at the stink granting children access to the cabinent was present. Additional personal hygiene products were also stored in the shower. LPA observed various cleaning products Clorox and insect killer stored in unsecured cabinet in the laundry area. LPA observed sunscreen sprays and a lighter accessible children which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/04/2025
Plan of Correction
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Licensee will ensure all poisons and cleaning products are centrally stored and inaccessible to children in care. Licensee will remove all poisons from facility and make cleaning products and personal hygiene products inaccessible. POC will be cleared by visit.

Type B
Section Cited
CCR
102418(a)
Prior to admission to a family child care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in C1 was missing proof of immunizations which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/04/2025
Plan of Correction
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License will all children in care have proof of immunizations. Licensee wil obtain proof of C1's immunizations. POC will be cleared by visit.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Karen Chambers
NAME OF LICENSING PROGRAM MANAGER:
Tyler Reyes
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/21/2025


LIC809 (FAS) - (06/04)
Page: 5 of 10
Document Has Been Signed on 08/21/2025 02:51 PM - It Cannot Be Edited


Created By: Tyler Reyes On 08/21/2025 at 01:52 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CHILDS FAMILY DAY CARE
FACILITY NUMBER: 197400552

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(1)
The provider shall physically check on the infant every 15 minutes

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview with Licensee and record review, the licensee did not comply with the section cited above Licensee has not been using a 15-min sleep log has to document C1’s sleep which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/04/2025
Plan of Correction
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Licensee will ensure to physically check on the infant every 15 min and document every 15 min check. Licensee will provide proof of sleep log for C1. POC will be cleared by visit.
Type B
Section Cited
CCR
102416(c)
The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric carddiopulmonary resuscitation and pediatric cardiopulmonary resusciataion and pediatric first aid, pursuant to Health and Safety Code Section 1596.866

This requirement is not met as evidenced by:
Deficient Practice Statement
1
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3
4
Based on interview and record review, the licensee did not comply with the section cited above in Licensee Wolita's and S1's CPR/First Aid was completed 12/10/2022 from American Red Cross which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/11/2025
Plan of Correction
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Licensee will obtain a current Pediatric CPR/First Aid. Licensee will provide proof of a valid Pediatric CPR/First Aid approved by Emergecny Medical Services Authority EMSA . POC will be cleared by visit.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Karen Chambers
NAME OF LICENSING PROGRAM MANAGER:
Tyler Reyes
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/21/2025


LIC809 (FAS) - (06/04)
Page: 4 of 10
Document Has Been Signed on 08/21/2025 02:51 PM - It Cannot Be Edited


Created By: Tyler Reyes On 08/21/2025 at 02:07 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CHILDS FAMILY DAY CARE
FACILITY NUMBER: 197400552

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(7)
An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to concent to emergency medical care.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in C3 was missing proof of Authorized Representative Signature on form LIC 627 Consent for Emergency Medical Treatment which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/04/2025
Plan of Correction
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2
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Licensee will ensure all children in care have LIC 627 form readily available. Licensee will provide proof of Authorized Representative Signature on form LIC 627 Consent for Emergency Medical Treatment for C3.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Karen Chambers
NAME OF LICENSING PROGRAM MANAGER:
Tyler Reyes
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/21/2025


LIC809 (FAS) - (06/04)
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