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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197492911
Report Date: 04/11/2025
Date Signed: 04/11/2025 02:14:58 PM

Document Has Been Signed on 04/11/2025 02:14 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:NEVAREZ FAMILY CHILD CAREFACILITY NUMBER:
197492911
ADMINISTRATOR/
DIRECTOR:		NEVAREZ, ELIZABETHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 808-9365
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
04/11/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Elizabeth Nevarez, Licensee TIME VISIT/
INSPECTION COMPLETED:
02:35 PM
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Licensing Program Analyst (LPA) Lilia Hernandez conducted an unannounced case management inspection on 04/11/2025 due to an incident that occurred at the facility. LPA arrived at the facility at 8:45AM and met with Elizabeth Nevarez, Licensee, who guided LPA on a tour of the facility. There was 1 infant and 6 preschool children in care. Licensee's spouse was also present during the inspection. Per Licensee, operation hours are Monday through Friday 6:30AM to 6PM.

The Department was notified that an incident had occurred at the home. At no time was the incident reported by the Licensee prior to today's inspection. Information regarding the incident at the home was reported to the public by the media. Media reports indicated that a firearm was used during the incident and a firearm may have been present in the home. Per Licensee, the incident was not reported to the Department because the incident occurred in the middle of the night outside of the Licensee's hours of operation on 03/24/2025.

On 11/06/2024, LPA Luque Avila conduced an annual inspection where Licensee disclosed and verified that there were no firearms in the home. Per Licensee, a firearm was obtained January of 2025. Per Licensee, during the annual inspection on 11/06/2024, Licensee was asked if there was a firearm in the home but was not informed that bringing a firearm into the home was part of reporting requirements.

LPA Hernandez advised Licensee that the department takes into consideration the overall maintenance of a licensed child care home to ensure the health, welfare and safety of children in care. Licensee was advised to contact the Department should they need consultation regarding regulations and/or consultation prior to changes in the home.
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Rita RamosTELEPHONE: (424) 301-3061
Lilia HernandezTELEPHONE: 424-301-3071
DATE: 04/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/11/2025
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: NEVAREZ FAMILY CHILD CARE
FACILITY NUMBER: 197492911
VISIT DATE: 04/11/2025
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LPA Hernandez also provided Licensee with information regarding reporting requirements and a copy of the LIC624B Unusual Incident/Injury Report for Family Child Care Homes. LIC624B written report must be submitted to the Department within 7 days of the incident being reported to the Department.

LPA Hernandez conducted an interview with Licensee's spouse who disclosed where and how the firearm in the home was stored prior to the incident. Based on disclosure and written statement provided by the Licensee spouse, storage of firearm and ammunition may have met regulation requirements. However, Licensee did not report obtaining a firearm in January of 2025 for the Department to conduct an inspection to confirm the firearm and ammunition storage met regulation requirements. Spouse also confirmed that during the incident, a firearm was used in self-defence in which an adult individual was injured. Due to an open investigation, the firearm is currently not in the home.

Based upon information received from the interviews conducted and written statements provided, the following deficiencies listed on the attached LIC 809D are being cited in accordance with California Code of Regulations Title 22.

LPA informed licensee that this report dated 04/11/2025 documents a Type A citation which shall be posted for 30 consecutive days as there was an immediate risk(s) to the health, safety, or personal rights of children in care.

LPA also informed the licensee to provide a copy of this licensing report dated 04/11/2025 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), or other written statement, must be placed in the child's file for verification.

The 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 maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted and report was reviewed with Elizabeth Nevarez, Licensee.
SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Lilia HernandezTELEPHONE: 424-301-3071
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/11/2025 02:14 PM - It Cannot Be Edited

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: NEVAREZ FAMILY CHILD CARE
FACILITY NUMBER: 197492911

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/11/2025
Section Cited
CCR
102417(g)(4)

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(4) Poisons, detergents...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:
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Per Licensee, firearm is no longer in the home. If firearm is brought back into the home, Licensee shall ensure to report firearm in the home immediately to the Department so that the Department can endure that the firearm and ammunition is stored per regulation requirements.
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Based on interviews, Licensee did not report obtaining a firearm in January of 2025 for the Department to conduct an inspection to confirm the firearm and ammunition storage met regulation requirements which posed an immediate 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 RamosTELEPHONE: (424) 301-3061
Lilia HernandezTELEPHONE: 424-301-3071

DATE: 04/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/11/2025

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/11/2025 02:14 PM - It Cannot Be Edited

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: NEVAREZ FAMILY CHILD CARE
FACILITY NUMBER: 197492911

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/11/2025
Section Cited
HSC
1597.467(b)(1)(C)

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(b)(1) A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence...(C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child.
This requirement is not met as evidenced by:
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Per Licensee, any future incidences or injuries in the home will be reported to the Department before the close of the next working day following the occurrence. If Licensee is unsure if an incident is reportable, Licensee will contact the Department for consultation.
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Interviews with Licensee and , the incident that occurred at the home on 03/24/2025 outside of hours of operations where an adult individual was injured with a firearm was not reported to the department which posses 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 RamosTELEPHONE: (424) 301-3061
Lilia HernandezTELEPHONE: 424-301-3071

DATE: 04/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/11/2025

LIC809 (FAS) - (06/04)
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