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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197408734
Report Date: 08/13/2025
Date Signed: 08/13/2025 05:01:34 PM

Document Has Been Signed on 08/13/2025 05:01 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:ARRIAGA FAMILY CHILD CAREFACILITY NUMBER:
197408734
ADMINISTRATOR/
DIRECTOR:		ARRIAGA/C/ANTONIOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 573-7152
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 13DATE:
08/13/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:35 PM
MET WITH:Catalina Arriaga, LicenseeTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
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On 08/13/2025 at 01:35 PM, Licensing Program Analyst (LPA) Elicia Calvillo conducted an unannounced Annual Continuation Inspection at 15639 Ludlow Street, Granada Hills, CA 91344. LPA identified self and met with Catalina Arriaga, Licensee. Upon arrival Licensee was alone with 13 children. Licensee guided LPA on tour of the inside and outside of the facility. LPA provided Licensee with a copy of the LIC126 Entrance Checklist -Family Child Care Homes to help facilitate the inspection. Licensee cares for children from ages 3 months to 13 years. The facility hours of operation are Monday to Friday from 07:30AM to 05:30PM. At 02:12 PM, Catherine “Collette” Arriaga, Licensee’s daughter and assistant arrived at the facility. At 02:30 PM, Co-Licensee, Antonio Arriaga arrived at the facility.

The purpose of today’s visit is to complete the 3 Year Annual Required Inspection that was started on 04/23/2025.

The licensee provided proof of control of property.

The family child care home is a one-story dwelling, with combination living / dining room, kitchen, 3 bedrooms, 3 bathrooms, den/sleeping room, attached garage/eating/activity area, laundry room, a detached classroom, and no garage. There is a front yard that is used for children to enter and exit the facility and use as a secondary play area. There is a fenced play yard at the back of the house.

The children enter the facility from the front yard through a side gate. There is an unfenced front yard that is

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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Elicia Calvillo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2025
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 12
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ARRIAGA FAMILY CHILD CARE
FACILITY NUMBER: 197408734
VISIT DATE: 08/13/2025
NARRATIVE
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There is an unfenced front yard that is used by parents and children to enter the facility and is used as a secondary play area. LPA advised Licensee and Assistant (daughter) that children will need to be supervised at all times when playing in the front yard.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The children use the attached garage (photos taken) is used as an indoor / outdoor area for child care activities and eating. LPA observed there are tables and chairs, toys and play items that are safe, clean, and appropriate for the ages of the children. LPA observed that children were in the play yard or attached garage, per Licensee and Assistant (daughter) the children spend most of their day outdoors in the attached garage area. Per Licensee and Assistant (daughter), the children have unstructured free play on Monday and Friday and have prepared activities on Tuesday, Wednesday, and Thursday.

The detached classroom (photo taken) is used for structured child care activities and sleeping. LPA arrived during nap time and observed children sleeping on cots and in pack n plays. During the visit while Licensee was alone, Child #1 began crying in the detached classroom, LPA waited for Licensee to respond to the crying child, LPA expressed concern for Child #1 and went find out if Child #1 was in distress, Licensee followed LPA and went to aide Child #1 LPA observed tables and chairs and a few play items.

The den (photo taken) located near the attached garage is used for sleeping children. LPA observed there are pack n’ plays and bed linens available for children. LPA observed there were 6 children sleeping.

Personal items (back packs) are stored on a table by the entrance gate and diapers are and in the den where there are individual cubbies used for personal items.

The licensee provides food for children in care. Licensee stated when food is brought to the facility it is labeled with child’s name and stored properly.

The children use the bathroom #3 located in the detached classroom. The vanity cabinet holds hand soap and paper products, and LPA observed the vanity cabinet is secured with a child proof latch. LPA observed that the bathroom that children use was safe and sanitary.

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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Elicia Calvillo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
LIC809 (FAS) - (06/04)
Page: 3 of 12
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ARRIAGA FAMILY CHILD CARE
FACILITY NUMBER: 197408734
VISIT DATE: 08/13/2025
NARRATIVE
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Per Licensee, when a child shows signs of illness they will be separated from other children and isolated in the den/sleeping room.

There is a telephone service via a cellphone. LPA advised Licensee that the cellphone must remain in the facility during the hours of operations.

The outdoor play area is located at the back yard of the house and is fenced. LPA observed appropriate toys and other play equipment for children in care. The outdoor play yard is covered with cement and artificial grass. The children have access to a climbing structure that is secured to the ground and there is rubber material under and around the climbing structure to absorb falls. LPA observed adequate shade with canopy over the play area. LPA observed there were hazards to children present.

Per Licensee, areas off limits to children and parents includes combination living/dining room, 3 bedrooms, 2 bathrooms, laundry room and are made inaccessible by use of door locks.

Per Licensee, there are no firearms or other weapons on the premises. LPA did not observe any firearms or other weapons on the premises.

Per Licensee, there are no poisons on the premises. LPA did not observe any poisons during the inspection. Poisons, detergents, medicines, and other items which could pose a danger if readily available to children are stored where they are inaccessible to children.

Per Licensee, there are no pets on the premises. LPA did not observe any pets on the premises.

Per Licensee, there are no bodies of water. LPA did not observe any swimming pool, wading pools, hot tubs, spas, fish ponds, fountains or other similar bodies of water.

LPA did not observe any fireplace. LPA did observe an open face portable heater during the inspection.
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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Elicia Calvillo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ARRIAGA FAMILY CHILD CARE
FACILITY NUMBER: 197408734
VISIT DATE: 08/13/2025
NARRATIVE
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There is a working fire extinguisher, the valve on the 2A 10BC fire extinguisher indicates indicates fully charged and per Licensee it was purchase about 2 months ago.

LPA observed a devised on the ceiling of the detached classroom, per Licensee the device does work but it was not tested due to the children were napping in the room. LPA did not observe any other devices. LPA did not observe a carbon monoxide detector in the facility, per Licensee there is no carbon monoxide detector in the facility.

There is currently four (4) infants enrolled with the facility. 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.

LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, trampoline and/or any other item that fall into these categories are not permitted in a family child care facility.

Licensee was reminded that children in care are to be supervised at all times and made aware that children shall not be left in parked vehicles. Car seats shall only be used for transportation purposes and shall not be used for sleeping.

Emergency Disaster Plan was not posted and not readily available upon request. The Parent’s Rights Poster and the Facility License were observed to be posted.

A Child Care Roster of children was not readily available upon request. During the inspection, Catherine “Collette” Arriaga, Licensee’s daughter and assistant created a hand written list of children and parent names.
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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Elicia Calvillo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
LIC809 (FAS) - (06/04)
Page: 5 of 12
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ARRIAGA FAMILY CHILD CARE
FACILITY NUMBER: 197408734
VISIT DATE: 08/13/2025
NARRATIVE
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On 04/23/2025, during an 3 Year Annual Inspection, LPA reviewed a sample of children’s files and observed files were not complete and documented on the LIC857. The children’s files were missing the following: 12 out of 13 files missing the Immunization Record, 9 out of 13 files missing Identification and Emergency Information, 10 out of 13 files missing Notification of Parents’ Rights, 3 out of 3 Infant files missing Sleeping Plan, and 3 out of 3 Infant files missing 15-minute Sleep Log. During today’s inspection, Catherine “Collette” Arriaga, Licensee’s daughter and assistant, informed LPA that the children’s records were not available at the facility because she has all the children’s records are at her home.

On 04/23/2025, during a 3 Year Annual Inspection, LPA reviewed one (2) staff record and observed that the files were not complete and documented on the LIC 859. The staff records were missing the following: 2 out 2 records were missing current Pediatric CPR/First Aid, 1 out 2 missing Immunization Record, 1 out 2 missing TB Clearance Record, 1 out 1 missing Mandated Reporter training completion certificate. During today’s inspection, Catherine “Collette” Arriaga, Licensee’s daughter and assistant, informed LPA that the staff records were not available at the facility because all the staff records are at her home.

An emergency fire/disaster drill has not been completed and documented within the last 6 months. Mandated Reporter Training was unavailable for the Licensee. Licensee’s pediatric CPR/First Aid was expired.

LPA reviewed with licensee the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children's forms/records, facility forms/records, and information to be posted.

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

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

All adults who reside or work in the home do not have a criminal record clearance or exemption. There are no excluded individuals present at this home. 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 Page 5 of 7
NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Elicia Calvillo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
LIC809 (FAS) - (06/04)
Page: 6 of 12
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ARRIAGA FAMILY CHILD CARE
FACILITY NUMBER: 197408734
VISIT DATE: 08/13/2025
NARRATIVE
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 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.

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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care­ licensing/subscribe and select the Child Care option to receive email communication.

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 www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Elicia Calvillo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
LIC809 (FAS) - (06/04)
Page: 7 of 12
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ARRIAGA FAMILY CHILD CARE
FACILITY NUMBER: 197408734
VISIT DATE: 08/13/2025
NARRATIVE
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During today's visit, per Title 22, Division 12, Chapter 3, of the California Code of Regulations, there was one (1) Type A Citation issued for section 102416.5(e) Staffing Ratio and Capacity with a plan of correction due on 08/14/2025. LPA informed the Licensee to provide a copy of this licensing report dated 08/13//2025 that documents any Type A citation(s) to parents/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 (LIC 9224) (LPA provided a copy of the form), or other written statement, must be placed in the child's file for verification.

During today’s visit, per per Title 22, Division 12, Chapter 3, of the California Code of Regulations, there were five (5) Type B Citations issued for sections 102391(d) Inspection Authority of the Department, 102416.1(a) Personnel Records, 102425(j)(2)(D) Infant Safe Sleep, 102425(c) Infant Safe Sleep, and 102417(g)(8) Operation of A Family Child Care Home and a plan of correction is due on 09/15/2025.

A Notice of Site Visit was given and must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to comply with posting requirement will result in an immediate civil penalty of $100.00.



The Exit interview was conducted with Catalina Arriaga, Licensee including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Elicia Calvillo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
LIC809 (FAS) - (06/04)
Page: 8 of 12
Document Has Been Signed on 08/13/2025 05:01 PM - It Cannot Be Edited


Created By: Elicia Calvillo On 08/13/2025 at 04:01 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: ARRIAGA FAMILY CHILD CARE
FACILITY NUMBER: 197408734

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/14/2025
Section Cited
CCR
102416.5(e)

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Staffing Ratio and Capacity(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home .... This requirement is not met as evidenced by:
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Licensee stated that when they are without an assistant provider they will send children home to stay within staffing ratio and capacity.
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Based on observation, interview, record review, the licensee did not comply with the section cited above in that the Licensee was alone without an assistant provider at the facility which poses an immediate health, safety or personal rights risk to persons in care.
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 Licensse stated they will review the CDSS website and view the videos on Staffing Ration and Capacity and provide LPA with an summary by the plan of correction due date 08/14/2025

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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.
Rita Ramos
NAME OF LICENSING PROGRAM MANAGER:
Elicia Calvillo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2025


LIC809 (FAS) - (06/04)
Page: 9 of 12
Document Has Been Signed on 08/13/2025 05:01 PM - It Cannot Be Edited


Created By: Elicia Calvillo On 08/13/2025 at 04:07 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: ARRIAGA FAMILY CHILD CARE
FACILITY NUMBER: 197408734

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/15/2025
Section Cited
CCR
102391(d)

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Inspection Authority of the Department (d) The licensee shall permit the Department to inspect, audit, and copy children's records or other family child care home records upon demand during normal business hours....This requirement is not met as evidenced by:
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Licensee stated they will have all the children's records completed and at the facility by the plan of correction due date 09/15/2025. Licensee stated they will notify LPA by email when the records are available at the facility.
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Based on observation, interview, record review, the licensee did not comply with the section cited above in that no children's records were at the facility and not readily available upon request which poses a potential health, safety or personal rights risk to persons in care.
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Type B
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Section Cited
CCR102416.1(a)

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Personnel Records (a) Personnel records shall be maintained on each employee and shall contain the following information:This requirement is not met as evidenced by:
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Licensee stated they will have all the staff/persibbek records completed and at the facility by the plan of correction due date 09/15/2025. Licensee stated they will notify LPA by email when the records are available at the facility.
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Based on observation, interview, record review, the licensee did not comply with the section cited above in that no personnel records were at the facility and not readily available upon request which poses a potential health, safety or personal rights risk to persons 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.
Rita Ramos
NAME OF LICENSING PROGRAM MANAGER:
Elicia Calvillo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/13/2025 05:01 PM - It Cannot Be Edited


Created By: Elicia Calvillo On 08/13/2025 at 04:13 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: ARRIAGA FAMILY CHILD CARE
FACILITY NUMBER: 197408734

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/15/2025
Section Cited
CCR
102425(j)(2)(D)

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Infant Safe Sleep Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:This requirement is not met as evidenced by:
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Licensee stated they will have all the infant/ children's records completed and at the facility by the plan of correction due date 09/15/2025. Licensee stated they will notify LPA by email when the records are available at the facility.
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Based on observation, interview, record review, the licensee did not comply with the section cited above in that no infant children's records were at the facility and not readily available upon request which poses a potential health, safety or personal rights risk to persons in care.
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Type B
09/15/2025
Section Cited
CCR102425(c)

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Infant Safe Sleep An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.This requirement is not met as evidenced by:
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Licensee stated they will have all the infant/ children's records completed and at the facility by the plan of correction due date 09/15/2025. Licensee stated they will notify LPA by email when the records are available at the facility.
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Based on observation, interview, record review, the licensee did not comply with the section cited above in that no infant children's records were at the facility and not readily available upon request which poses a potential health, safety or personal rights risk to persons 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.
Rita Ramos
NAME OF LICENSING PROGRAM MANAGER:
Elicia Calvillo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2025


LIC809 (FAS) - (06/04)
Page: 11 of 12
Document Has Been Signed on 08/13/2025 05:01 PM - It Cannot Be Edited


Created By: Elicia Calvillo On 08/13/2025 at 04:17 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: ARRIAGA FAMILY CHILD CARE
FACILITY NUMBER: 197408734

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/15/2025
Section Cited
CCR
102417(g)(8)

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Operation of A Family Child Care Home (8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.This requirement is not met as evidenced by:
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Licensee stated they will have all the current roster of children completed and at the facility by the plan of correction due date 09/15/2025. Licensee stated they will email LPA a copy when it is completed.
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Based on observation, interview, record review, the licensee did not comply with the section cited above in that no children's roster or children's records were at the facility and not readily available upon request which poses a potential health, safety or personal rights risk to persons 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.
Rita Ramos
NAME OF LICENSING PROGRAM MANAGER:
Elicia Calvillo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2025


LIC809 (FAS) - (06/04)
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