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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197407790
Report Date: 04/29/2026
Date Signed: 04/29/2026 03:03:23 PM

Document Has Been Signed on 04/29/2026 03:03 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:VASQUEZ FAMILY CHILD CAREFACILITY NUMBER:
197407790
ADMINISTRATOR/
DIRECTOR:		VASQUEZ, LIZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 220-7568
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY: 14TOTAL ENROLLED CHILDREN: 3CENSUS: 3DATE:
04/29/2026
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:10 PM
MET WITH:Licensee Liz VasquezTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
NARRATIVE
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On 4/29/2026 at 1:10pm Licensing Program Analyst (LPA), Jeanine Lipsey conducted an unannounced Case management Inspection for proof of correction and was met by Licensee Liz Vasquez to whom the purpose of the visit was given. LPA observed 3 children being supervised by licensee.

On 2/10/26, the home was cited for the following citations:
The children's bathroom the electrical out let cover is missing. The outlet is still missing the cover. There are bags of manure near the children's play structures, the manure has not been removed. The off limit areas need locks on doors or baby gate. The off limit areas are still accessible to the children. The fire extinguisher has not been serviced within 2 years. The licensee has not had the fire extinguisher serviced as of todays date. The children's bathroom has shampoo/bodywash in the shower. Licensee removed all products from the bathroom. No proof of drills conducted. LPA observed proof of drills conducted. Licensee is missing proof of TB, T-dap, measles, flu vaccination/declination, and adult living in the home missing TB. LPA observed proof of TB test and flu from licensee and staff. Licensee is till missing Measles and T-dap. Licensee completed online CPR which is not permitted. LPA observed proof of CPR training from the American Heart Association. All children were missing LIC 282 affidavit for liability insurance. LPA observed signed LIC 282 in the children's files.

Exit interview conducted and report was reviewed with the Licensee Liz Vaquez. A notice of site visit was given and must remain posted for 30 days

NAME OF LICENSING PROGRAM MANAGER: Betty Bell
NAME OF LICENSING PROGRAM ANALYST: Jeanine Lipsey
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/29/2026
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 4
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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Document Has Been Signed on 04/29/2026 03:03 PM - It Cannot Be Edited


Created By: Jeanine Lipsey On 04/29/2026 at 01:29 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: VASQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 197407790

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/29/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/20/2026
Section Cited
CCR
102417(g)

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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:
This requirement is not met as evidenced by
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Licensee will correct all items by POC date.
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Based on observation, the licensee did not comply with the section cited above in that The children's bathroom the electrical out let cover is missing, bags of manure near the children's play structures. The off limit areas need locks or baby gate
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 which poses/posed a potential health, safety or personal rights risk to persons in care.
Type B
05/20/2026
Section Cited
CCR102417(g)(1)

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 Operation of A Family Child Care Home
The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.
This requirement is not met as evidenced by
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Licensee will have the fire extinguisher serviced or purchase a new one by the POC date.
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Based on observation and interview, the licensee did not comply with the section cited above in that fire extiguisher has not been served within 2 years which poses/posed 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.
Betty Bell
NAME OF LICENSING PROGRAM MANAGER:
Jeanine Lipsey
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/29/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/29/2026


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 04/29/2026 03:03 PM - It Cannot Be Edited


Created By: Jeanine Lipsey On 04/29/2026 at 01:40 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: VASQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 197407790

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/29/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/13/2026
Section Cited
CCR
1597.622(c)

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Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations....

This requirement is not met as evidenced by
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Licensee will provide proof of vaccinations by POC date.
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Based on record review, the licensee did not comply with the section cited above in that the Licensee is missing proof of T-dap, and measles, which poses/posed 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.
Betty Bell
NAME OF LICENSING PROGRAM MANAGER:
Jeanine Lipsey
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/29/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/29/2026


LIC809 (FAS) - (06/04)
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