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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197405926
Report Date: 09/17/2025
Date Signed: 09/19/2025 07:20:10 AM

Document Has Been Signed on 09/19/2025 07:20 AM - 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:MASSEY FAMILY CHILD CAREFACILITY NUMBER:
197405926
ADMINISTRATOR/
DIRECTOR:		MASSEY, CAROLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 291-0595
CITY:LOS ANGELESSTATE: CAZIP CODE:
90043
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 7DATE:
09/17/2025
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:25 PM
MET WITH:Carol Massey, LicenseeTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
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On 09/17/2025 Licensing Program Analyst (LPA) Dawn Dowling conducted an unannounced Annual Required Inspection and met with Licensee, Carol Massey. Days and hours of operation are Monday through Saturday 06:00 am to 7:00 pm.

LPA toured the inside of the home and a census was taken. An Entrance checklist (LIC 126) was provided to Licensee at the start of today's inspection.

Home consists of a Living room , Bedroom with bathroom downstairs, Kitchen, Upstairs Bedroom and Bathroom, family room used for primary child care room, 1/2 bathroom in family room, Deck, backyard and side of drive way used for outside play area as well as children are taken to local park for outings and play time, Laundry Room,

On Limit area is Living Room, Family room (Main child care area has table and chairs for children to eat and do homework on), 1/2 Bathroom located off child care room, Backyard and driveway.

Off limit area is Downstairs Bedroom with Bathroom made inaccessible by keeping door shut, , Kitchen, Upstairs bedroom and bathroom made inaccessible by a gate, laundry room-made inaccessible by door knob lock.

There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible. There is a defunct fireplace in the family room and is made inaccessible as it is sealed off.

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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Dawn Dowling
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/17/2025
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: MASSEY FAMILY CHILD CARE
FACILITY NUMBER: 197405926
VISIT DATE: 09/17/2025
NARRATIVE
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 Capacity as specified on the license is being maintained.

LPA Dowling observed 7 children in care during today's inspection. Licensee resides in home with her daughter and grand daughter. Licensee daughter is an Assistant and is fingerprint cleared, Granddaughter is fingerprint cleared as well.

LPA Dowling reviewed children’s files and observed files were complete with:

· LIC 282- Affidavit Regarding Liability Insurance


· LIC 700 Identification and Emergency Information
· LIC 627 Consent for Emergency Medical Treatment
· LIC 995A Notification of Parent's Rights
· Immunization Record
· Infant Sleeping Chart for Infant Under 24 Months of Age


LPA Dowling reviewed Personnel records of Licensee and Assistants as follows:
  • Licensee- American Red Cross Adult and Pediatric First Aid/ CPR was taken 07/28/2025 expires 07/28/2027
  • Mandated Reporter Certificate taken 06/18/2025 expires 06/26
  • Provided proof of Immunization of Pertussis
  • Provided Declination of Flu Shot
  • Licensee did not have proof of Immunization of Measles, Mumps, Rubella (MMR) and will obtain proof of immunization and email to LPA.


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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Dawn Dowling
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025
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: MASSEY FAMILY CHILD CARE
FACILITY NUMBER: 197405926
VISIT DATE: 09/17/2025
NARRATIVE
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Assistant file showed proof of the following:
  • Mandated Reporter Certificate taken 06/18/2024 expires 06/2026.
  • American Red Cross Adult and Pediatric First Aid/CPR taken 07/28/2025 expires 07/2027.

Assistant did not have proof of Immunization of Measles, Mumps, Rubella (MMR), Pertussis or TB Clearance will obtain proof and email to LPA.

Licensee informed that this deficiency will result in a Type B citation for immunization.

LPA Dowling observed following documents posted on bulletin board in living room accessible to parents:

· Facility License


· PUB 394- Notification of Parents Rights
· LIC 9148- Earthquake Preparedness
· LIC 610A- Emergency Disaster Plan

Licensee has Disaster and Fire Drills-last one conducted on 08/08/2025 at 11:30 am.

Licensee provides meals and snacks for children in care. Children do not bring food from home. LPA discussed with Licensee if child brings food from home to label it and store separate from other children's food.

Children have cots to sleep on, bedding is provided by licensee, is washed every other day. Children have cubbies and coat rack to store their personal belongings . If a child has an accident bedding is immediately removed and bedding is changed and washed.

Isolation area is the living room if a child is sick in order to keep away from other children in care while they wait for parent to pick up.

State law prohibits baby walkers, bouncy seats, exer-saucers and any other items that fall into that category. LPA did not observe any prohibit items in home.

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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Dawn Dowling
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025
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: MASSEY FAMILY CHILD CARE
FACILITY NUMBER: 197405926
VISIT DATE: 09/17/2025
NARRATIVE
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Criminal Record Statement Family Child Care Homes

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Safe Sleep:

LPA Dowling observed Licensee is documenting as required the Sleep Charts for child 24 months or younger in care and is charting the 15 minute sleep chart appropriately.

Safe sleep regulation was discussed with licensee as well as the Child Care Licensing Safe Sleep web page listed below that licensee can utilize as an additional resource.https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep

The licensee is advised to never shake a baby to prevent Shaken Baby Syndrome.

Licensee reminded that only children eating may be in high chairs and that car seats are utilized only for transportation.

Medication :

LPA Dowling discussed medication with Licensee does not give medication.. Medication was discussed and licensee informed if medication is given to ensure it is labeled and made inaccessible to children in care.

Incidental Medical Services (IMS) policy

For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Dawn Dowling
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025
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: MASSEY FAMILY CHILD CARE
FACILITY NUMBER: 197405926
VISIT DATE: 09/17/2025
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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: http://www.ada.gov/childqanda.htm

LPA Dowling observed children in care were in caring and nurturing environment and treated with dignity and respect.

Type B deficiency was cited during today's inspection (see LIC 809Ds)

Exit interview conducted with Licensee. A copy of this report, notice of site inspection, Appeal Rights (LIC 9058), were given and explained.

LPA discussed with Licensee the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Dawn Dowling
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/19/2025 07:20 AM - It Cannot Be Edited


Created By: Dawn Dowling On 09/17/2025 at 04:34 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: MASSEY FAMILY CHILD CARE
FACILITY NUMBER: 197405926

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/17/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

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 2 out of 2 people do not have proof of immunization for Measles, Mumps , Rubella (MMR) and 1 staff did not have proof of Pertussis Immunization or TB Clearance which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/01/2025
Plan of Correction
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Licenses will provide LPA proof of Immunization for Measles, Mumps ,Rubella (MMR)
Licensee will provide LPA proof of Immunization for Assistant for Measles, Mumps, Rubella (MMR), Pertussis and TB Clearance on or before Plan of Correction date.
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.
Raul Navarro
NAME OF LICENSING PROGRAM MANAGER:
Dawn Dowling
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/17/2025


LIC809 (FAS) - (06/04)
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