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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192009402
Report Date: 07/17/2026
Date Signed: 07/22/2026 02:43:46 PM

Document Has Been Signed on 07/22/2026 02:43 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:LOPEZ FAMILY CHILD CAREFACILITY NUMBER:
192009402
ADMINISTRATOR/
DIRECTOR:		LOPEZ, ANA MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 599-4870
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
07/17/2026
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Staff assistant, Silvia MorenoTIME VISIT/
INSPECTION COMPLETED:
12:40 PM
NARRATIVE
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THIS IS AN AMENDED REPORT THAT SUPERSEDES THE PREVIOUS.

On 07/17/2026 at 09:00AM Licensing Program Analyst(LPA) Melissa Zaragoza conducted an unannounced case management visit. LPA stated the purpose of the visit was to ensure the health, safety, and personal rights risks to children in care are being met. LPA was greeted and granted access by the Staff Assistant, (A1) Silvia Moreno.

When LPA arrived at the facility, LPA observed 6 children in care with A1 and A2 and 1 child arrived later on. A1 informed A2 to care and supervise children while A1 gave LPA a tour of the facility. When LPA inquired about licensee's whereabouts and reviewed criminal record clearance, it was determined that A2 idoes not have a criminal record clearance. LPA observed A1 on the phone. A1 confirmed that they were speaking to the Licensee and then LPA was informed that A2 is the cleaning person. Since A2 was observed in the presence of the 6 children in care and was actively supervising children upon arrival the follow deficiency is being cited, 1 Type A deficiency and a civil penalty of $100 dollars is being assessed, for having an un-fingerprinted adult at the facility, actively providing care.



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Rita Ramos
Melissa Zaragoza
DATE: 07/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/17/2026
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: LOPEZ FAMILY CHILD CARE
FACILITY NUMBER: 192009402
VISIT DATE: 07/17/2026
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THIS IS AN AMENDED REPORT THAT SUPERSEDES THE PREVIOUS.
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LPA was also informed during the visit that the Licensee was not present due to an emergency, however, A1 also informed LPA that the License will not be available until Tuesday, 07/22/26. Although information was provided that the Licensee was not available due to an emergency. Since it was determined that the Licensee was absent on today’s visit and may not return for days, a Type B deficiency will be cited. Furthermore, the department did not received any prior notice that the Licensee will be absent from the facility for days while children would still be in care.

LPA was at the facility on 02/23/26 to conduct an annual visit and observed a 2nd unit in the back yard of the property (no separate address) and occupied. On this date of 07/17/26, LPA Zaragoza observed that the unit was vacated. LPA reminded staff that if there are any changes to the composition of the home, it would need to be reported to the department.

LPA Melissa Zaragoza informed staff assistant, Silvia Moreno, that this report dated 07/17/2026 documents 1 Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Melissa Zaragoza informed the staff assistant, Silvia Moreno to provide a copy of this licensing report dated 07/17/2026 that documents any Type A citation 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.


During today’s visit there is 1 Type A deficiency issued with a civil penalty of $100 dollars, and 1 Type B deficiency

A notice of site visit was provided and shall remain posted for 30 days. Appeal Rights were provided.Exit interview was conducted and report was reviewed with the staff assistant, Silvia Moreno.

NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Melissa Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/17/2026 12:11 PM - It Cannot Be Edited


Created By: Melissa Zaragoza On 07/17/2026 at 11:37 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: LOPEZ FAMILY CHILD CARE
FACILITY NUMBER: 192009402

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/17/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/24/2026
Section Cited
CCR
102417(a)

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(a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times...

This requirement is not met as evidenced by:
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As a plan of the correction the licensee must notify the department of any future absence and shall be present in the home.
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Based on observations and interviews the license left for emergency on 07/17/2026 and left staff assistant to operate while they are out of town. Licensee failed to inform the department of their absence. which poses an potential health, safety, and personal rights risk to children 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:
Melissa Zaragoza
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/17/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/17/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/17/2026 12:11 PM - It Cannot Be Edited


Created By: Melissa Zaragoza On 07/17/2026 at 11:43 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: LOPEZ FAMILY CHILD CARE
FACILITY NUMBER: 192009402

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/17/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/18/2026
Section Cited
HSC
1596.871(c)(1)(A)

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Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

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As a plan of correction, Per Staff 2 (S2) they will not clean the home during operating hours. Per S2, they will renew their passport as soon as possible, in order to complete a background fingerprint check, and obtain criminal record clearance.
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Based on observation and record review, the licensee did not comply with the section cited above by having an adult provide care to chilren without criminal record clearance, which poses 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 Ramos
NAME OF LICENSING PROGRAM MANAGER:
Melissa Zaragoza
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/17/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/17/2026


LIC809 (FAS) - (06/04)
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