197494895-5-15-2026-58-CC-DFEN-DU4UPB-20260515154514

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494895
Report Date: 05/15/2026
Date Signed: 05/15/2026 03:45:42 PM

Document Has Been Signed on 05/15/2026 03:45 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:	SONG FAMILY CHILD CARE		FACILITY NUMBER:	197494895
ADMINISTRATOR/ DIRECTOR:	SONG, LEI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 903-0256
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90049
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 12	CENSUS: 11	DATE:	05/15/2026
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:30 PM
MET WITH:	Lei Song		TIME VISIT/ INSPECTION COMPLETED:	04:00 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	On 05/15/2026 at 12:30pm, Licensing Program Analyst (LPA) DeCondia Ferguson conducted an Unannounced Required 3-Year inspection at Song Family Child Care (Little Ivy Preschool). Upon arrival, LPA was met by Xuedi Liu (Gabby), who is a teacher’s assistant, as the licensee was away from the home. Licensee, Lei Song arrived at the facility at 12:50pm. LPA discussed the purpose of the visit. The LIC125 Entrance Checklist was provided to help facilitate the inspection. The Licensee guided LPA on a tour of the facility inside and out. Days and hours of operation are 08:30am to 02:30pm Monday through Friday. All required postings were observed. During today’s inspection, LPA observed child care being provided outside during the time of the inspection. During today’s visit a census was taken. LPA observed a total of 11 children present being supervised by 1 staff and 1 volunteer. Licensee stated there are 12 children enrolled. A walk through of the facility space was conducted. All rooms were inspected: #3 Master Bedroom, Room #4 Son’s Bedroom, two additional bathrooms (#2 and #3) in the living quarters, Kitchen and Living Room are off limits. On limit rooms include Classroom #1, Classroom #2 and Bathroom #1, and Back Yard, which are used as the child care areas. The activity space was found to be clean and free from any potential hazards. Page 1

NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Decondia Ferguson
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/15/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2026

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 NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SONG FAMILY CHILD CARE	FACILITY NUMBER: 197494895
	VISIT DATE: 05/15/2026

NARRATIVE

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Napping takes place in classroom #1. Parents provide blankets and sheets for each child, which are taken home weekly on Fridays for laundering. The program maintains additional linens on site for use in the event of accidents or as needed. Per licensee, in the event children become ill the designated isolation area is outside under supervision until parents arrive or are taken to classroom #2 when not in use by other children.

Furniture was in good repair and equipped with age-appropriate furniture, toys, and materials. All cleaning compounds, medications, and other hazardous items were observed to be inaccessible to children. No poisons were observed in the area occupied by children or bathrooms. All floors were observed to be clean and safe. All materials accessible to children were observed to be toxic-free.

The bathroom and toileting area was inspected. Toilet and sink are properly maintained; toilet and sinks are reachable by the children in care. The bathrooms were found to be clean. There is adequate lighting/ventilation in the bathroom area. Cleaning agents, detergents, and other hazardous substances are securely stored separately using cabinets with safety latches. Solid waste containers were observed to have tight-fitting covers and be in good repair.

Telephone service, heating, lighting and ventilation were evaluated and found to be adequate. Per Licensee there is no smoking on the premises. No firearms in the home. No registered sex offenders. No pools or bodies of water were observed on the premises.

LPA observed tamper-resistant electrical outlets installed throughout the facility. The facility is equipped with operational smoke and carbon monoxide detectors, tested during the inspection. Fire extinguisher (2A:10BC) was observed. Technical Assistance was provided for Fire Extinguisher inspection/service tag indicates the unit has not been serviced within the recommended interval at the time of inspection. LPA recommends evaluation and servicing by a qualified fire protection contractor.

The First Aid kit was complete and is located in bathroom #1 between Classrooms #1 and #2. Facility was observed to be operating within the conditions, limitations, and capacity specified on the license. At least one person was observed to be trained in CPR and Pediatric 1st Aid.

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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Decondia Ferguson
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/15/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2026

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 NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SONG FAMILY CHILD CARE	FACILITY NUMBER: 197494895
	VISIT DATE: 05/15/2026

NARRATIVE

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The outdoor play area was inspected, all fully enclosed and fenced. Outdoor play equipment was observed to be maintained in a safe condition and free of hazards. The outdoor activity surface was observed to be safe and free of debris. Required cushioning material was present beneath and around climbing structures to absorb falls. There is adequate shade in the play yard. LPA advised that no children shall be left without the supervision of a teacher at any time.

Per the Licensee, parents provide lunch and snacks for the children in care. Children lunches are labeled and have ice packs included. Per Licensee Incidental Medical Services (IMS) are not offered. Per licensee there is one (1) child who is allergic to eggs but since meals are not provided this is not a concern. Drinking water was observed to be readily available indoors and outdoors. Water is available to children through personal water bottles and is refilled using a Brita water system.

Children’s records were reviewed for Admission Agreement, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, LIC 613-Personal Rights, LIC 702-Health History, and Immunization Records and were found to be complete.

Staff records were reviewed for Education, LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, LIC503- Health Screening, Proof of immunization 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. All required immunizations were documented. There is at least one person trained in CPR and Pediatric First Aid and at least one person with one hour of training in the importance of childhood nutrition during this inspection. All staff present had current criminal record clearances on file.

During today’s inspection, LPA Ferguson observed the following:

Physical Plant - Technical Assistance: 102417(g)(1) - Fire Extinguisher inspection/service tag indicates the unit has not been serviced within the recommended interval at the time of inspection. LPA recommends evaluation and servicing by a qualified fire protection contractor or purchase a new fire extinguisher and maintain receipt/proof of purchase. Licensee was reminded fire extinguishers are required to be serviced annually.
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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Decondia Ferguson
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/15/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2026

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 NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SONG FAMILY CHILD CARE	FACILITY NUMBER: 197494895
	VISIT DATE: 05/15/2026

NARRATIVE

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The Licensee was reminded that CPR/First Aid and Mandated Reporter training must be renewed every two years.

Requirements for disaster drills and documentation for both were reviewed. Last Fire Drill conducted 01/29/2026.

Licensee has Liability Insurance on file

Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. Licensee was advised on how to access quarterly reports, forms, and regulations for Child Care online at www.ccld.ca.gov.

The licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified. Regulation prohibits the smoking of tobacco on the premises. Licensee’s state there is no smoking in the home. Licensee’s state there are no firearms on the premises.

The following were also discussed with the licensee’s:

Criminal Record Clearance - Licensee Lei Song 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.

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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Decondia Ferguson
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/15/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2026

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 NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SONG FAMILY CHILD CARE	FACILITY NUMBER: 197494895
	VISIT DATE: 05/15/2026

NARRATIVE

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Assembly Bill 633: Upon receipt of a citation for a Type A Deficiency, the director shall post the licensing report for 30 days in addition to the Notice of Site Visit & provide copies of the licensing report (LIC 809D/9099D) to parents/guardians of children in care at the facility by the close of business the following day or the next day child returns to the facility. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee will obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file.

Senate Bill 792: This bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles.

New Immunization Requirement: Law enacted by SB 277, beginning January 1, 2016, personal beliefs exemptions will no longer be an option for the vaccines that are currently required for entry into child care or school in California. Personal beliefs exemptions already on file will remain valid until the child reaches the next immunization checkpoint.

New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment. All appeals must be sent to:

Safe Sleep - LPA discussed the safe sleep regulations with licensee [or facility representative] and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [or facility representative] 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.

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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Decondia Ferguson
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/15/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2026

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 NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SONG FAMILY CHILD CARE	FACILITY NUMBER: 197494895
	VISIT DATE: 05/15/2026

NARRATIVE

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Incidental Medical Services (IMS) - 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/.

California Department of Social Services | Community Care Licensing Division
300 Continental Blvd. Suite 290 A
El Segundo, CA 90245

MyChildCarePlan.org – Licensee Lei Song 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.

Megan’s Law - During the exit interview, the Licensee Lei Song, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS 05/15/2026.

Assembly Bill 1207: California Child Care Workers; Mandated Training Requirement. Beginning January 1, 2018, all licensed providers, applicants, directors and employees must complete Mandated Reported Training prior to March 30, 2018 and renew training every two years at: www.mandatedreporterca.com.

Nutrition Requirement: Beginning January 1, 2016, AB 290 will require for each new license issued, at least one director or teacher at each child care center or family child care home to have at least one hour of training in the importance of childhood nutrition. This applies to anyone submitting a new application, relocating their facility, selling their facility or transferring their license. Please note this training cannot be completed online or by home study programs. The training must be taken from an Emergency Medical Services Authority (EMSA) approved training program OR an accredited college or university.

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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Decondia Ferguson
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/15/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2026

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 NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SONG FAMILY CHILD CARE	FACILITY NUMBER: 197494895
	VISIT DATE: 05/15/2026

NARRATIVE

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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

Exit interview conducted and report was reviewed with the licensee Laura Montoya

A notice of site visit was given and must remain posted for 30 days. Appeal rights were provided.

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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Decondia Ferguson
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/15/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2026

LIC809 (FAS) - (06/04)

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