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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197408694
Report Date: 06/09/2026
Date Signed: 06/09/2026 01:06:35 PM

Document Has Been Signed on 06/09/2026 01:06 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 RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:COUCHOIS FAMILY CHILD CAREFACILITY NUMBER:
197408694
ADMINISTRATOR/
DIRECTOR:		COUCHOIS, CATHLEEN C.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 828-9698
CITY:SANTA MONICASTATE: CAZIP CODE:
90404
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 14DATE:
06/09/2026
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:50 AM
MET WITH:Cathleen "CC" CouchoisTIME VISIT/
INSPECTION COMPLETED:
11:40 AM
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On 06/09/2026 Program Analysts (LPA) Judy Laureano and Patsy Plancarte conducted an unannounced a 3 Year Required Inspection at the above-mentioned facility. LPAs were greeted J. Fuerte, Assistant. LPAs discuss the purpose of the visit with Licensee Cathleen “CC” Couchious.

LPA toured the inside and outside of the home and observed 14 children with licensee and licensee’s husband and two additional staff members providing care and supervision.

LPA confirmed via Guardian roster that all individuals present in the home have a clear criminal record clearance.

Facility operates Monday through Friday from 7:30 a.m. to 5:30 p.m. Currently licensee is available to care for children 3 months to 5 years old. Facility is Large Family Child Care Home with a max capacity of 14. Facility is NOT available for weekend care and/or evening care.

The home is a 3-bedroom, 2 bathroom single family unit with a living room, dining room and kitchen area, front yard and back yard. Licensee confirmed that children nap in the living room area. Licensee confirmed the following areas are used for day care: Living room, dining room and bathroom. Kitchen area is used only to prepare meals and snacks, children are not allowed in the space, safety gate was observed.

The following areas were confirmed to be designated as OFF LIMITS to the children in care: Bedroom 1, Bedroom 2 and Primary bedroom and bathroom and kitchen.

There are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds are kept away from the children. Facility has three cats that are kept away from the children; cats are in the primary bedroom- off limits area.

NAME OF LICENSING PROGRAM MANAGER: Loyce Phillips
NAME OF LICENSING PROGRAM ANALYST: Judy Laureano
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/09/2026
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 RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: COUCHOIS FAMILY CHILD CARE
FACILITY NUMBER: 197408694
VISIT DATE: 06/09/2026
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All electrical outlets were observed to be covered. LPAs reminded licensee to ensure all areas that have been designated as OFF LIMITS need to have doors closed doors when children are present.

LPAs observed age appropriate toys and materials for children to use. Families access the day care through main entrance of the home.

A small hallway was observed that leads to the bedroom and bathroom. Bathroom that children use is located next to the bedrooms. LPAs observed and inspected the toilet, sink and bathroom area. LPAs reminded licensee to ensure all toiletries are made inaccessible to the children in care and/or while children are present.

Kitchen was observed and inspected. Home provides meals and snacks. LPAs discussed the importance of maintaining a system where allergies and food restrictions are noted. LPAs encouraged licensee to contact their local resource and referral agency, Connections for Children, to inquire about the different resources and professional development opportunities available.

Parent board was observed by the entrance of the home with all the necessary posting. LPAs provided licensee with the most up to date posting to ensure Licensee is displaying the most current information.

The licensee was informed that any changes to ages, hours and days of operation shall be submitted to the department via signed LIC 279, for approval prior to initiation of changes.

Licensee confirmed that home open to take in children that need incidental medical services. LPAs discussed incidental medical services with Licensee. Prescription medications shall be administered in accordance with the label directions as prescribed by the child’s physician. Medication should be in its original content with current prescription with all necessary LIC forms completed. Currently Licensee does not have anyone enrolled that needs medication.

LPAs observed licensee test the smoke detector and carbon monoxide in the home. A working fire extinguisher was observed in the area. LPAs reminded licensee that fire extinguishers need to be service annually and proof of such service needs to be available for LPA’s review.

Licensee confirmed that fire drills and earthquake drills are completed. LPA remind licensee to ensure all drills are documented. Adequate heating and ventilation for safety and comfort were observed in the space. The home has a working telephone service and LPA confirmed the phone number and email address.

NAME OF LICENSING PROGRAM MANAGER: Loyce Phillips
NAME OF LICENSING PROGRAM ANALYST: Judy Laureano
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2026
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 RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: COUCHOIS FAMILY CHILD CARE
FACILITY NUMBER: 197408694
VISIT DATE: 06/09/2026
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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for and removing any recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.


Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22- 02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee Cathleen Couchois, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Cathleen "CC" Couchois.

NAME OF LICENSING PROGRAM MANAGER: Loyce Phillips
NAME OF LICENSING PROGRAM ANALYST: Judy Laureano
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2026
LIC809 (FAS) - (06/04)
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