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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493660
Report Date: 06/10/2026
Date Signed: 06/10/2026 06:03:09 PM

Document Has Been Signed on 06/10/2026 06:03 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:FERNANDEZ FAMILY CHILD CAREFACILITY NUMBER:
197493660
ADMINISTRATOR/
DIRECTOR:		LESLIE FERNANDEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 886-0905
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
06/10/2026
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:55 AM
MET WITH:Licensee Leslie FernandezTIME VISIT/
INSPECTION COMPLETED:
06:15 PM
NARRATIVE
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On 06/10/2026 at 9:55 AM, Licensing Program Analyst (LPA) Samantha Barba and Licensing Program Manager (LPM) Emiko Bell conducted an unannounced required-3 year inspection at the above facility. Upon arrival, LPA/LPM were greeted by Licensee Leslie Fernandez, to whom the purpose of the visit was announced and an Entrance Checklist – Family Child Care Homes was provided to help facilitate the inspection. Licensee guided LPA/LPM on a tour of the home. Also present was Licensee’s assistant Valentina Giraldo. There were (7) seven day care children present during today’s inspection. Per Licensee, there are currently 12 children enrolled. The facility's maximum capacity is 14 children, as it is a large Family Child Care Home. Licensee stated that her hours of operation are Mon.-Fri. 7:00 AM – 6:00 PM.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. This is a one-story home which consists of 4 bedrooms 2 bathrooms, kitchen, dining room, living room, laundry room, attached garage, front yard and backyard which had a pool. Per Licensee, areas off limits to children include: Master bedroom and ensuite bathroom, laundry room, bedrooms 2,3,4, and the attached garage. Per Licensee, areas that are accessible to children (on limits) include: kitchen, living room (playroom), bathroom #2, dining room and backyard. The bathroom that children use is located in the hallway between bedroom #4 and the laundry room and was observed to be clean and free of hazards.



Food and snacks are provided by Licensee. Licensee was reminded that if children bring food from home, it must be labeled with the child’s name and properly stored or refrigerated.

PAGE 1 OF 6
NAME OF LICENSING PROGRAM MANAGER: Betty Bell
NAME OF LICENSING PROGRAM ANALYST: Samantha Barba
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/10/2026
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 13
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: FERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197493660
VISIT DATE: 06/10/2026
NARRATIVE
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During the tour, LPA and LPM observed knives and bottles of alcohol accessible to children in care but were corrected during the visit. The licensee has 3 dogs, 2 of which are kept away from the children. All dogs have their paperwork. LPA took pictures and measurements of the pool are 12:53 pm, Licensee stepped away to pick up 3 school aged children and returned at 1:03 pm which during that time, assistant was left with 7 children, 2 of whom were infants, which made the facility be out of ratio for 10 minutes. During the report writing, LPM Bell stepped out at 2:05 pm and returned at 2:55 pm during which time, LPA Barba remained at the facility to continue to write the report. At 2:28 pm, Licensee’s assistant went home.


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. Individuals residing in the home have been discussed and noted. Licensee's mother, Rebecca Negrete, has been residing in the home since May 23 and does not have background clearance. A Type A citation and a $500 civil penalty has been assessed.


The following were observed and reviewed during this inspection:

LPA reviewed required posted documentation for facility, Facility License, PUB 394- Notification of Parent Rights and LIC 9148- Earthquake Preparedness form. Facility records were reviewed for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log. The last drill was conducted on June 2, 2026.

The isolation area for sick children waiting to be picked up is in the living room on a mat, away from the other children. There are toys and other age-appropriate materials available for children.

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NAME OF LICENSING PROGRAM MANAGER: Betty Bell
NAME OF LICENSING PROGRAM ANALYST: Samantha Barba
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2026
LIC809 (FAS) - (06/04)
Page: 3 of 13
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: FERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197493660
VISIT DATE: 06/10/2026
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Smoke and carbon monoxide detectors were tested and are operable. LPA observed the required (2A-10BC) fire extinguisher was mounted and located in a kitchen cabinet near the refrigerator; it was last serviced 01/26/26. LPA Barba reminded Licensee that a required (2A-10BC) fire extinguisher must be purchased or charged yearly. The home maintains telephone service via cell phone. The home is observed to be clean and orderly. The electric fireplace is screened to prevent access by children. LPA observed that detergents, cleaning compounds and medication are stored under the sinks or behind closed cabinets, inaccessible to children. Licensee states that there are no poisons stored in the home and understands that all poisons must be locked, not only inaccessible to children. Per Licensee there are no firearms or weapons stored in the home.

Infant Care: Currently, licensee cares for 2 infants. LPA observed 2 play yards visible in the living room. Napping equipment does not block entrances or exits. Infant mattresses were observed to be firm with tightly fitted sheets. LPA did not observe loose objects, bumpers, objects hanging, or objects attached to the cribs/play yards. There are currently no infants with pacifiers. Per licensee, wet or soiled sheets are immediately put in the washer and cleaned. Each infant has their own crib/play yard and bedding. Bedding is washed every other day. LPA informed licensee of the new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months. Licensee states the following sleep supervision plan for infants: all children sleep in the living room and are being supervised. LPAs 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. When asked if a parent brings an infant to the facility asleep in their car seat what should the Licensee do, Licensee stated "we take them out of the car seat and lay them to sleep”. Licensee stated they currently do not have children who get dropped off in car seats.

LPAs 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.

PAGE 3 OF 6

NAME OF LICENSING PROGRAM MANAGER: Betty Bell
NAME OF LICENSING PROGRAM ANALYST: Samantha Barba
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2026
LIC809 (FAS) - (06/04)
Page: 4 of 13
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: FERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197493660
VISIT DATE: 06/10/2026
NARRATIVE
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Currently, children are using the back yard for outdoor play. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that could be hazardous to children in care. There is a pool that is fenced off for the children’s safety but one area of the fencing is ripped which licensee has addressed and has an appointment for repairs on 6/11/26.The pool was also missing the US coast guard approved life ring, pool alarm, rescue pole with body hook as well as the daily inspection log.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunizations Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, LIC 9227- Infant sleep form for children 0-12 months. Licensee is aware they are receiving a Type B citation for not having a 15-minute check for sleep log for the infants enrolled.

Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate.

— Pediatric First Aid and CPR expires: January 2027
— Mandated Reporter AB1207 expires: October 2026

During inspection all children were observed to be treated with dignity and respect, they were observed to be receiving safe, healthful, and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment.

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NAME OF LICENSING PROGRAM MANAGER: Betty Bell
NAME OF LICENSING PROGRAM ANALYST: Samantha Barba
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2026
LIC809 (FAS) - (06/04)
Page: 5 of 13
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: FERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197493660
VISIT DATE: 06/10/2026
NARRATIVE
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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

Licensee was reminded of their responsibility to report suspected child abuse. Mandatory Forms for the children’s files and provider’s files were discussed. Licensee was made aware that state law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.

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.

Licensee was also reminded that only children eating may be in highchairs and that car seats are utilized only for transportation.

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&Rs) throughout California.

PAGE 5 OF 6
NAME OF LICENSING PROGRAM MANAGER: Betty Bell
NAME OF LICENSING PROGRAM ANALYST: Samantha Barba
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2026
LIC809 (FAS) - (06/04)
Page: 6 of 13
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: FERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197493660
VISIT DATE: 06/10/2026
NARRATIVE
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The licensee was advised the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, (Type A violation), a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed. The Licensee was made aware they may file an appeal, in writing 15 business days from the date of receiving the penalty assessment.

Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety. (A violation regarding uncleared adults, warrants an immediate civil penalty of $100 per day and is hereby assessed, see LIC 421BG), Type B citations ratio, infant sleep log, TB clearance, MMR immmunization, pool inspection log, pool life ring, pool alarm missing and rescue pole missing. One technical violation is being assessed for torn mesh fencing around the pool which will be fixed the following day.

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 inspection experience. If you have any questions regarding the process or tools, please send them by email 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/process.

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit.

Exit interview conducted and report was reviewed with licensee Leslie Fernandez.

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

PAGE 6 OF 6

NAME OF LICENSING PROGRAM MANAGER: Betty Bell
NAME OF LICENSING PROGRAM ANALYST: Samantha Barba
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2026
LIC809 (FAS) - (06/04)
Page: 7 of 13
Document Has Been Signed on 06/10/2026 06:03 PM - It Cannot Be Edited


Created By: Samantha Barba On 06/10/2026 at 03:10 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: FERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197493660

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(k)
Criminal Record Clearance
(k) The licensee shall maintain documentation of criminal record clearances or criminal record exemptions of employees, volunteers that require fingerprinting and non-client adults residing in the facility.

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 which licensee's mother, Rebecca Negrete, moved in on May 23, 2026 and does not have a criminal background clearance,which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/11/2026
Plan of Correction
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Licensee will take mother to get background clearance and inform LPA as soon as they have completed the step.
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.
Betty Bell
NAME OF LICENSING PROGRAM MANAGER:
Samantha Barba
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/10/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2026


LIC809 (FAS) - (06/04)
Page: 8 of 13
Document Has Been Signed on 06/10/2026 06:03 PM - It Cannot Be Edited


Created By: Samantha Barba On 06/10/2026 at 03:10 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: FERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197493660

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.814(a)(1)(B)(ii)(I)
Pool Safety
(ii) (I) An alarm that, when placed in a swimming pool, will sound upon detecting an entrance into the water. The alarm shall be turned on and be in working condition during a facility’s operating hours while the swimming pool is not in use.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above with not having a pool alarm which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/19/2026
Plan of Correction
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Licensee ordered a pool alarm, which is scheduled to be delivered in two days.
Type B
Section Cited
HSC
1596.814(a)(2)(A)
Pool Safety
(a) A licensed family daycare home operated at a private single-family dwelling with an in-ground swimming pool on the premises shall comply with all of the following requirements: (2) The licensee shall have the following safety equipment visible from the swimming pool and readily available for immediate use: (A) A life ring with a minimum exterior diameter of 17 inches and labeled as approved by the United States Coast Guard.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above because she did not have a life ring which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/19/2026
Plan of Correction
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Licensee ordered a life ring, which is scheduled to be delivered in two days.
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:
Samantha Barba
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/10/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2026


LIC809 (FAS) - (06/04)
Page: 9 of 13
Document Has Been Signed on 06/10/2026 06:03 PM - It Cannot Be Edited


Created By: Samantha Barba On 06/10/2026 at 03:10 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: FERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197493660

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.814(a)(2)(B)
Pool Safety
(a) A licensed family daycare home operated at a private single-family dwelling with an in-ground swimming pool on the premises shall comply with all of the following requirements: (2) The licensee shall have the following safety equipment visible from the swimming pool and readily available for immediate use: (B) A rescue pole with a body hook and a minimum fixed length of 12 feet.

This requirement is not met as evidenced by:
Deficient Practice Statement
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3
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Based on observation and interview, the licensee did not comply with the section cited above by not having a rescue pole which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/19/2026
Plan of Correction
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Licensee ordered a rescue pole, which is scheduled to be delivered in two days.
Type B
Section Cited
HSC
1596.814(a)(3)
Pool Safety
(a) A licensed family daycare home operated at a private single-family dwelling with an in-ground swimming pool on the premises shall comply with all of the following requirements: (3) A licensee shall perform a daily inspection of the drowning prevention safety features and safety equipment before opening the facility and maintain a log of the inspections to be provided to the department upon request.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation,record review and interview, the licensee did not comply with the section cited above by not keep record of daily pool inspections which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/19/2026
Plan of Correction
1
2
3
4
Licensee will begin a daily log as proof of inspections.
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:
Samantha Barba
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/10/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2026


LIC809 (FAS) - (06/04)
Page: 10 of 13
Document Has Been Signed on 06/10/2026 06:03 PM - It Cannot Be Edited


Created By: Samantha Barba On 06/10/2026 at 03:10 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: FERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197493660

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation,record review and interview, the licensee did not comply with the section cited above with keeping a log for the infants which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/19/2026
Plan of Correction
1
2
3
4
Licensee will begin keeping track of infant sleep with 15 minute checks and logging them. It was observed that the infants along with all children were supervised during naps but no log was filled.
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview and record review the licensee did not comply with the section cited above with staff and adult resident missing proof of TB Clearance which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/19/2026
Plan of Correction
1
2
3
4
Licensee will have staff 3 and staff 4 get TB clearance and provide verification to LPA.
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:
Samantha Barba
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/10/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2026


LIC809 (FAS) - (06/04)
Page: 11 of 13
Document Has Been Signed on 06/10/2026 06:03 PM - It Cannot Be Edited


Created By: Samantha Barba On 06/10/2026 at 03:10 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: FERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197493660

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2026

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
1
2
3
4
Based on observation and record review the licensee did not comply with the section cited above with staff missing vaccination which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/17/2026
Plan of Correction
1
2
3
4
Licensee will have staff send proof of missing vaccinations
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, record review and interview, the licensee did not comply with the section cited above by not keeping a log for the current infants in care sleep log which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/19/2026
Plan of Correction
1
2
3
4
Licensee will begin to keep a sleep log which they will check infants every 15 minutes and log it. LPA observed during nap time that children were supervise but no sleep log was filled.
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:
Samantha Barba
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/10/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2026


LIC809 (FAS) - (06/04)
Page: 12 of 13
Document Has Been Signed on 06/10/2026 06:03 PM - It Cannot Be Edited


Created By: Samantha Barba On 06/10/2026 at 03:10 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: FERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197493660

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.5(e)
Staffing Ratio and Capacity
(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).

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 when picking up children from school, assistant was left with 2 infants and 5 children which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/19/2026
Plan of Correction
1
2
3
4
Licensee will ensure that there is enough staff to cover ratio
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.
Betty Bell
NAME OF LICENSING PROGRAM MANAGER:
Samantha Barba
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/10/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2026


LIC809 (FAS) - (06/04)
Page: 13 of 13