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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197407702
Report Date: 01/09/2026
Date Signed: 01/09/2026 02:43:48 PM

Document Has Been Signed on 01/09/2026 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:PLAZA FAMILY CHILD CAREFACILITY NUMBER:
197407702
ADMINISTRATOR/
DIRECTOR:		LOURDES G. PLAZAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 415-2576
CITY:LOS ANGELESSTATE: CAZIP CODE:
90043
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 8DATE:
01/09/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Lourdes G Plaza, LicenseeTIME VISIT/
INSPECTION COMPLETED:
02:50 PM
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Licensing Program Analyst(LPA) Dawn Dowling conducted an unannounced annual required inspection at the above facility on 01/09/2026 9:30 AM, Licensee, Lourdes G. Plaza answered the door..
LPA Dowling provided Licensee with a copy of the LIC 126 Entrance Checklist to help facilitate the inspection. There were 8 children and 2 adults present when LPA arrived. Facility capacity is in compliance for a large Family Child Care Home. Hours of operation are Monday through Friday 8:00 am to 6:00 pm.

LPA toured the home inside and outside. This is a two story home which consists of 2 bedrooms, 2 bathrooms, kitchen, dining room, living room on upstairs area; downstairs area is primary child care area that has spiral staircase which leads to 2nd level of home has wooden gate that prevents children from accessing stairs, lower level of home has family room which is used for child care, 1 bathroom for child care children, past children's bathroom is small kitchen area and laundry room which are off limits to children in care. Front and back yard is fenced off. Day care children use back yard when weather permits, there is upper area that has Large play structure in good repair is enclosed by gate, lower back yard area has toys and play equipment in good repair. Licensee indicated grass will be cut due to weather gardener had not been out in awhile to cut grass. In going to backyard area LPA observed pesticide spray bottle and 3 paint cans near the trash cans, LPA reminded Licensee to have locked up or stored away from children in care, if children come outside ensure these items are either locked up or thrown in trash cans with lids. LPA did not observe a pool or other bodies of water on premises.

There are no firearms or ammunition on the premises. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible as they are stored in laundry room and bathroom out of children's reach. LPA did not observe any open faced heaters in child care area.

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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Dawn Dowling
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2026
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: PLAZA FAMILY CHILD CARE
FACILITY NUMBER: 197407702
VISIT DATE: 01/09/2026
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Smoke Detector and Carbon Monoxide were tested and operable. First Aid kit was complete. There is adequate heating and ventilation for safety and comfort. Fire extinguisher located in the corner of child care room was serviced on 01/05/2026. Safe toys and play equipment are observed. Capacity as specified on the license is being maintained.

Licensee resides in home with her spouse who is fingerprint cleared.

LPA Dowling observed following documents posted on bulletin board in child care area when you first walk into which is accessible to parents:

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

Documents are posted in Spanish and English for Parents to Review.
  • Licensee does not have Disaster and Fire Drills conducted, LPA reminded licensee this is required once every six months to have documented and provided licensee with paperwork to conduct drill. This will be a Type B deficiency.
LPA Dowling reviewed children’s files and observed files were complete with:
  • LIC 700- Identification and Emergency Information
  • LIC 627- Consent for Emergency Medical Treatment (1 child missing this child came today due to emergency- Assistant's family member)
  • LIC 995A- Notification of Parents Rights
  • Immunization Record(5 out of 10 children do not have immunization Records on File-Type B Deficiency)

Licensee does not have the following in children's files:
  • Infant Sleeping Chart for Infant 12 months of age and Under
  • Infant Sleeping Chart for Infant 24 months of age and Under
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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Dawn Dowling
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2026
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: PLAZA FAMILY CHILD CARE
FACILITY NUMBER: 197407702
VISIT DATE: 01/09/2026
NARRATIVE
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Licensee given form and informed that this deficiency will result in a Type B citation, Licensee informed to document for each infant and place in file.

LPA reviewed Licensee and Assistants records as follows:

  • Assistant- Mandated Reporter Certificate taken 03/22/2024 expires 03/2026
  • Heart Saver issued by American Heart Association Pediatric CPR and First Aid Certificate taken 08/12/2025 expires 08/27
  • Chest X-ray cleared for TB clearance
  • Immunization for Tdap (Pertussis), Measles, Mumps and Rubella (MMR)
  • Declination for Influenza (Fiu shot)

Licensee does not have application or the following documents on file for Assistant:
  • LIC 608- Criminal Record Statement
  • LIC 9052 Employees Rights

Licensee given Technical Advisory and reminded to have Assistant or future employees file prepared like children's files and have required documentation in each employees files.

Licensee records reviewed as follows:

  • Mandated Reporter Certificate taken 03/20/2024 expires 03/2026.
  • Heart Saver issued by American Heart Association Pediatric CPR and First Aid Certificate taken 07/25/2024 expires 07/2026.
  • TB Clearance
  • Immunization Record for DTap(Pertussis), Measles, Mumps, Rubella (MMR)\

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

DATE: 01/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2026
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: PLAZA FAMILY CHILD CARE
FACILITY NUMBER: 197407702
VISIT DATE: 01/09/2026
NARRATIVE
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  • Declination of Influenza (Flu) Shot

Licensee provides meals and snacks for children in care. Licensee reminded if child brings food from home to label with child's name on it and store separately.

Children have mats to sleep on, licensee provides the blankets for children in care which are washed every Saturday. If a child has an accident bedding is immediately removed and bedding is changed and washed.

Isolation area is the front of the child care room, licensee or assistant will sit with child until a parent or authorized representative can pick child 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.

Smoking Prohibition:

Smoking is prohibited on the premises of a Family Child Care Home as specified in Health and Safety Code Section 1596.795(a)

Per Licensee, no one in the home smokes.

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.

LPA Dowling advised licensee infants must be monitored every 15 minutes when sleeping, their breathing, temperature and color of skin should also be monitored. Safe Sleep regulation was discussed with licensee as well as the Child Care Licensing Safe Sleep webpage 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

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

DATE: 01/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2026
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: PLAZA FAMILY CHILD CARE
FACILITY NUMBER: 197407702
VISIT DATE: 01/09/2026
NARRATIVE
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The licensee is advised to never shake a baby to prevent Shaken Baby Syndrome.

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

Medication :

LPA Dowling discussed medication with Licensee, currently Licensee gives medication that has been prescribed by child's Doctor and it is kept separate with child's name and instructions for giving medication on the label. Medication is 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 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.

Licensee confirmed that there are no registered Sex Offenders living in the home.


LLPA and Licensee discussed 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.

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

Type B deficiencies were cited during today's inspection (see LIC 809Ds). The Licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days.

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

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

DATE: 01/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2026
LIC809 (FAS) - (06/04)
Page: 6 of 12
Document Has Been Signed on 01/09/2026 02:43 PM - It Cannot Be Edited


Created By: Dawn Dowling On 01/09/2026 at 02:19 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: PLAZA FAMILY CHILD CARE
FACILITY NUMBER: 197407702

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review the licensee did not comply with the section cited above in licensee is not conducting required fire and emergency drills which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/16/2026
Plan of Correction
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Licensee will conduct a Fire Drill and an Earthquake drill once every six months and provide LPA with proof via email.
Type B
Section Cited
CCR
102425(j)(2)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above as licensee is not conducting 15 minute check on infants in care as required which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/16/2026
Plan of Correction
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Licensee will begin documentating 15 minute sleep on infant 12 months and Under and for infants 24 months and Under that licensee has enrolled in care and will provide LPA proof of documentation via email.
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: 01/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/09/2026 02:43 PM - It Cannot Be Edited


Created By: Dawn Dowling On 01/09/2026 at 02:19 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: PLAZA FAMILY CHILD CARE
FACILITY NUMBER: 197407702

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(a)
Immunizations
(a) Prior to admission to a family day 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 observation, interview and record review, the licensee did not comply with the section cited above in 5 out of 10 children do not have immunization on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/23/2026
Plan of Correction
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Licensee will obtain proof of immlzations from parents and provide LPA with proof via email.
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: 01/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2026


LIC809 (FAS) - (06/04)
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