<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197413529
Report Date: 10/09/2025
Date Signed: 10/09/2025 01:15:00 PM

Document Has Been Signed on 10/09/2025 01:15 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:RUBIO FAMILY CHILD CAREFACILITY NUMBER:
197413529
ADMINISTRATOR/
DIRECTOR:		RUBIO, ALICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
3239719772
CITY:LOS ANGELESSTATE: CAZIP CODE:
90044
CAPACITY: 14TOTAL ENROLLED CHILDREN: 4CENSUS: 0DATE:
10/09/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:25 AM
MET WITH:Alicia Rubio, Licensee and Joscelyn Rubio, AssistantTIME VISIT/
INSPECTION COMPLETED:
01:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Shandra Powell conducted an unannounced Annual Random inspection on 10/09/2025. LPA was greeted by Licensee and Assistant. LPA introduced self and explained the nature of the visit. A copy of the Entrance Checklist for Child Care homes form (LIC 126) was provided to the licensee upon entry. LPA observed Facility License, Notification of Parents Rights, Earthquake Preparedness posted on parent board located at the front door of the home. LPA reviewed the Emergency Disaster Plan LIC610A, Disaster and Fire Drill Log was not available for review. This poses a health and safety risk to children in care no documentation to review. LIC9040 Facility Roster was observed with 4 enrolled. LPA did not observe any children in care during inspection.

Licensee and Assistant gave LPA a tour of the home inside and out. The facility operating hours/days are Monday through Sunday from 6:00am to 8:00pm (previously 24hour care). This is a one-story home. Per Licensee three other adults reside in the Family Child Care Home. All Adults present, residing and working in the home are fingerprint cleared and associated with the facility.
NAME OF LICENSING PROGRAM MANAGER: Karren Starks
NAME OF LICENSING PROGRAM ANALYST: Shandra Powell
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/09/2025
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 9
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)
Page: 2 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: RUBIO FAMILY CHILD CARE
FACILITY NUMBER: 197413529
VISIT DATE: 10/09/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
 LPA observed living room to be the main child care room with toys, cubbies, one play yard and cots for napping. This is a 3 bedroom home with drop down room off dining room used for a storage room. LPA observed bathroom #1 in hallway and 1/4 bathroom located in the drop down room next to dining/kitchen area. LPA observed an open concept living room, dining room and kitchen area. The dining area has a large family style table with chairs and bench. The home has a attached garage. The attached garage has been converted into a bedroom with a 1/2 bathroom inside. The attached garage can be accessed from the driveway and through Bedroom #1 Per licensee all bedrooms will be off limits made inaccessible with child proof knobs. LPA observed one child proof knob on bedroom #1 during inspection. Bathroom located in bedroom #1 is off-limits. Children in care will use bathroom #2 located off hallway and 1/4 bathroom located in the drop down room next to kitchen/dining room.

The On-Limit areas of the home are, the living/dining room area (main child care room) front yard and bathroom off hallway and bathroom located in drop down storage room.

The Off-Limit areas of the home are the back yard (due to construction) all bedrooms and bathroom located in master bedroom.

The isolation area will be located in the dining area on a cot/chair, per licensee.
NAME OF LICENSING PROGRAM MANAGER: Karren Starks
NAME OF LICENSING PROGRAM ANALYST: Shandra Powell
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
LIC809 (FAS) - (06/04)
Page: 3 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: RUBIO FAMILY CHILD CARE
FACILITY NUMBER: 197413529
VISIT DATE: 10/09/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. Home utilizes central air and heating for a cooling and heating source. Home has a working telephone. Hazardous materials in the kitchen and bathroom are inaccessible to children by child gate at the entrance of kitchen. According to the Licensee, there are no weapons or firearms at the home; None were observed by LPA. Per Licensee, there are no pets in the home; None were observed by LPA.

LPA observed a fire extinguisher which is at least 2A:10BC, however has not been serviced since July 2024. LPA requested licensee to have extinguisher serviced and send a copy of the serviced tag to LPA. Licensee and Assistant agreed. LPA reminded licensee that the fire extinguisher must be serviced yearly, and or a new fire extinguisher must be brought. The home is also equipped with a working smoke detector and carbon monoxide detector which was tested during inspection. There is also a first aid kit equipped in the home. LPA observed current First Aid and CPR certificates for Licensee and Assistant with an expiration date of 07/20/2026. Licensee and Assistant have not completed the retake training for Mandated Reporter training since 02/06/2023. Training must be completed every two years. This is a potential health and safety risk for children in care. Must be completed and certificates mailed or emailed to Regional Office.
LPA observed many toys and playthings which appeared to be safe for children in care and age-appropriate for the children. LPA observed a play yard for napping and cots. Play yard needed cleaning and or replace paddings around and at bottom of play yard. Play yard was cleaned during inspection.
NAME OF LICENSING PROGRAM MANAGER: Karren Starks
NAME OF LICENSING PROGRAM ANALYST: Shandra Powell
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
LIC809 (FAS) - (06/04)
Page: 4 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: RUBIO FAMILY CHILD CARE
FACILITY NUMBER: 197413529
VISIT DATE: 10/09/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
 Licensee agrees that no baby-walkers, bouncers, jumpers, exersaucers and similar items will not be used for children in care and are kept inaccessible; None were observed by LPA.

Per licensee the outside play for the children is conducted in the front yard due to the back yard being renovated and construction was observed during inspection by LPA. Licensee husband was working on the renovated area. The front and back yard are completely fenced. Licensee states the sliding gate in front yard will be closed while children are in play in front yard. Per Licensee, supervision of the children is always provided by Licensee and Assistant(s) during outside play time. The outside play area is free from defects or dangerous conditions. No pools, spas, hot tubs, fish ponds, or similar bodies of waters observed during the inspection.
LPA reviewed 3 children's files during today's inspection and observed the following Children's Records: Immunization Records, LIC 700 (Identification and Emergency Information), LIC 627 (Consent for Emergency Medical Treatment), LIC 995A (Notification of Parents' Rights).
The following was thoroughly discussed with Licensee:
License 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.
NAME OF LICENSING PROGRAM MANAGER: Karren Starks
NAME OF LICENSING PROGRAM ANALYST: Shandra Powell
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
LIC809 (FAS) - (06/04)
Page: 5 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: RUBIO FAMILY CHILD CARE
FACILITY NUMBER: 197413529
VISIT DATE: 10/09/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Incidental Medical Services (IMS):
Incidental Medical Services (IMS) policy was discussed. 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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm.

Incidental Medical Services (IMS) are not currently being provided.

LPA thoroughly discussed Safe Sleep Practices: always place infants on their backs for sleeping; use only a tight-fitting sheet on the crib or play yard mattress; do not hang any items from the crib or above the crib; keep all items, including blankets, out of the crib or play yard; pacifiers may be used as long as they do not have items attached to them; infants should not be swaddled or have any items covering them while sleeping; the temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold.

During this inspection, LPA did not observe an updated/current 15min sleep log for children in care needed for infants while napping during inspection this poses as a health and safety risk to children in care
NAME OF LICENSING PROGRAM MANAGER: Karren Starks
NAME OF LICENSING PROGRAM ANALYST: Shandra Powell
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
LIC809 (FAS) - (06/04)
Page: 6 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: RUBIO FAMILY CHILD CARE
FACILITY NUMBER: 197413529
VISIT DATE: 10/09/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot line at 1-800-540-4000. Also call the CCL office within 24 hours of all Unusual Incidents and follow up with a written Unusual Incident/Injury Report (LIC 624B) within 7 business days.

Licensee was reminded that all infants must be placed on their backs when sleeping to prevent S.I.D.S. (sudden infant death syndrome), and that the Provider is required to wash hands after every diaper change and to never shake a baby to prevent the Shaken Baby Syndrome


LPA advised the licensee to access forms, regulations and quarterly updates online at: www.ccld.ca.gov. License stated the facility has subscribed to receive Important updates during inspection.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for 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.
NAME OF LICENSING PROGRAM MANAGER: Karren Starks
NAME OF LICENSING PROGRAM ANALYST: Shandra Powell
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
LIC809 (FAS) - (06/04)
Page: 7 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: RUBIO FAMILY CHILD CARE
FACILITY NUMBER: 197413529
VISIT DATE: 10/09/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Deficiency Type B Citation and Technical Violations were issued during inspection to protect the children's health and safety.

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

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

Exit interview conducted and report was reviewed with the Licensee. Report, Appeal Rights and Notice of Site Visit were given to Licensee. The Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

NAME OF LICENSING PROGRAM MANAGER: Karren Starks
NAME OF LICENSING PROGRAM ANALYST: Shandra Powell
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
LIC809 (FAS) - (06/04)
Page: 8 of 9
Document Has Been Signed on 10/09/2025 01:15 PM - It Cannot Be Edited


Created By: Shandra Powell On 10/09/2025 at 12:44 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: RUBIO FAMILY CHILD CARE
FACILITY NUMBER: 197413529

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/09/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.3


This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. (a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following:
(4) Construction of exterior decks or porches.
POC Due Date: 10/10/2025
Plan of Correction
1
2
3
4
Licensee will have a written plan regarding construction and alterations to the home on paper and sent to LPA by POC date of 10/10/2025.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Karren Starks
NAME OF LICENSING PROGRAM MANAGER:
Shandra Powell
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/09/2025


LIC809 (FAS) - (06/04)
Page: 9 of 9