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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494863
Report Date: 07/17/2025
Date Signed: 07/17/2025 10:24:15 AM

Document Has Been Signed on 07/17/2025 10:24 AM - 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:HAGGERSTROM FAMILY CHILD CAREFACILITY NUMBER:
197494863
ADMINISTRATOR/
DIRECTOR:		CECILIA HAGGERSTROMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 633-3375
CITY:SANTA MONICASTATE: CAZIP CODE:
90404
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
07/17/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Cecilia Haggerstrom, LicenseeTIME VISIT/
INSPECTION COMPLETED:
10:35 AM
NARRATIVE
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On 7/17/2025 Licensing Program Analyst (LPA) Judy Laureano and Licensing Program Manager (LPM) Loyce Phillips conducted an unannounced case management inspection at the above-mentioned facility for the purpose of ensuring that standards are being met in accordance with California Tittle 22 Regulations and California Health and Safety Codes. LPA and LPM were greeted by Licensee, Cecelia Haggerstrom. Present during today's inspection were Licensee's two assistants, I. Rosales and M. Sanchez.

On 7/11/2025 Los Angeles Department of Health served a second Health Officer Order (HOO) indicating for licensee to close the facility immediately to all operations involving childcare. This includes feeding, hygiene care (diaper changes), supervised play, and sleeping arrangements. In addition, Licensee must comply with the DPH’s directives until the investigation has been cleared by DPH. This order is in effect until rescinded by the Los Angeles Department of Public Health.

LPA and LPM did not observed any children in care during today's inspections.

On 6/27/2025 DPH completed a site visit providing parent notification letter and container for sampling. On 7/7/2025 DPH notified Community Care licensing to inform us of gastrointestinal illnesses with children at the facility. Licensee failed to report to Community Care Licensing; Type A citation issued. Please see LIC 809D.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations and Health and Safety Code, A type A deficiency is cited.

NAME OF LICENSING PROGRAM MANAGER: Loyce Phillips
NAME OF LICENSING PROGRAM ANALYST: Judy Laureano
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/14/2025
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: HAGGERSTROM FAMILY CHILD CARE
FACILITY NUMBER: 197494863
VISIT DATE: 07/17/2025
NARRATIVE
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LPA Judy Laureano informed licensee Cecilia Haggerstrom that this report dated 07/17/2025 documents 1 Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Laureano informed the licensee Cecilia Haggerstrom to provide a copy of this licensing report dated 07/17/2025 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

The notice of Site Visit (LIC 9213) must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will results in a civil penalty of 100.00.

An exit interview was conducted, and a copy of this report and appeals rights was provided to Licensee Cecelia Haggerstrom


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

DATE: 07/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/17/2025 10:24 AM - It Cannot Be Edited


Created By: Judy Laureano On 07/14/2025 at 09:19 AM
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: HAGGERSTROM FAMILY CHILD CARE
FACILITY NUMBER: 197494863

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/15/2025
Section Cited
CCR
102416.2(a)(c)(3)

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(a) The licensee shall report the following information to the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm).
...(3) A communicable disease outbreak when determined by the local health authority.
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Licensee agrees to submit a signed Declaration stating she would be close until she has clearance of DPH. Licensee also agrees to view and sumbit a summary of understanting of as it pertains to reporting requierments.
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This requierment was not met as evidence by; on 7/7/2025 DPH notified Community Care licensing informing us of gastrointestinal illnesses with children at the facility. Licensee failed to report to CCL.
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Child Care Reporting Requierment Video: https://ccld.childcarevideos.org/family-child-care-providers/child-care-reporting-requirements/
Licensee agrees read sectioned cited 102416.2 (a)(c)(3) and provide summary of understanding.Summaries will be sent via email to LPA by 7/18/2025 by 5PM.

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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.
Loyce Phillips
NAME OF LICENSING PROGRAM MANAGER:
Judy Laureano
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/14/2025


LIC809 (FAS) - (06/04)
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