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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495241
Report Date: 09/11/2026
Date Signed: 09/11/2026 02:29:06 PM

Document Has Been Signed on 09/11/2026 02:29 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:PINA FAMILY CHILD CAREFACILITY NUMBER:
197495241
ADMINISTRATOR/
DIRECTOR:		ANGELA PINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 910-8830
CITY:LOS ANGELESSTATE: CAZIP CODE:
90045
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
09/11/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Angela PinaTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
NARRATIVE
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On 09/11/2026 Licensing Program Analysts LPAs Patsy Plancarte and Angela Luz conducted an unannounced Annual/Random inspection at the above-mentioned facility. LPAs were greeted by Licensee Angela Pina. Licensee walked LPAs toward the side entrance of the house. Parents use the side entrance to access the facility for drop off. Parents sign in using digital sign in sheet via Google. LPAs observed children’s cubbies in entry way. LPAs toured and inspected the facility in accordance with the facility sketch. Licensee provides Breakfast, Lunch, am and pm snack Monday—Thursday. Licensee provides only am and pm snack on Fridays parents provide Lunch. Lunch bags are labeled with children’s names. No food allergies and no medication needed for children at this time.

All Adults present, residing, working and/or volunteering in the home have a criminal record clearance or exemption.

The following was observed during today’s inspection:
The 1-bedroom, Sunroom, 1 bathroom and back yard are all ON- LIMITS
Facility is a single-family home. Days and hours of operation are Monday-Friday 7AM to 6PM is licensed to serve 14 children. Also present were 11 children (3 infant age and 7 preschool age), and an assistant.

ON-LIMIT areas were observed and inspected. Furniture and equipment are in good condition, free of sharp, loose or pointed parts. LPAs observed Sunroom and is maintained in a safe condition and is free of hazards. LPAs observed 1 play yard. LPAs reminded Licensee to add a fitted sheet to the play yard. Sunroom leads into the Bedroom, which is used for napping. Chemicals are stored in a high kitchen cabinet. The main day care space is the Sunroom, 1-Bedroom and 1 bathroom. LPAs observed a turtle tank with turtle in main day care space, play beads on rack, bookshelf with books TV, manipulatives, and activities for children to use. Floors in the facility are clean and safe. Licensee informed LPA the isolation area for children when they are ill would be in the area where the bookshelf is located.
Karren Starks
Patsy Plancarte
DATE: 09/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/11/2026
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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Document Has Been Signed on 09/11/2026 02:29 PM - It Cannot Be Edited


Created By: Patsy Plancarte On 09/11/2026 at 12:29 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: PINA FAMILY CHILD CARE
FACILITY NUMBER: 197495241

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/11/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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
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Based on record review, the licensee did not comply with the section cited above in one out of two Immunization record which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/25/2026
Plan of Correction
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Licensee will send a proof of assistants required Immunization record ( Measles and Pertussis)
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.
Karren Starks
NAME OF LICENSING PROGRAM MANAGER:
Patsy Plancarte
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/11/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/11/2026


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: PINA FAMILY CHILD CARE
FACILITY NUMBER: 197495241
VISIT DATE: 09/11/2026
NARRATIVE
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LPAs observed a fully charged 2A-10-BC fire extinguisher purchased in September 2026 on kitchen counter space. LPAs observed a working smoke detector plugged into the Kitchen counter area and a working carbon monoxide in the sun room (main day care space). Fire drill log was observed and lastly completed in June 2026. LPAs reminded Licensee to add the time and date the drill was completed.

At least one person trained in CPR and Pediatric First Aid is present when children are at the facility or at offsite activities. Licensee Pediatric CPR and Pediatric First Aid is current and expires the year of 2027. Licensee Mandated Reporter for Child Care Providers was available for review sent to LPA via email and is current. LPAs reminded Licensee and staff to have a copy in the file or review. LPAs reminded Licensee of their responsibility to ensure all Licensing related documents are available for review.

LPAs reviewed 5 children’s files and noted they are in compliance with documents required. LPAs reminded Licensee to transfer children's immunizations on the California Pre-Kindergarten and School Immunization Record.
LPAs reviewed 1 additional staff files. Assistant files was missing documentation of required immunizations. LPAs reviewed infant 15- minute checks and noted they were in compliance.

LPAs observed the outside space. LPAs noted 6 play cars, play and swing structure securely installed into the ground. The structure includes 2 swings. LPAs noticed a house climbing structure and a Kitchen mud pay area with age appropriate toys for children to engage in play. LPA noticed in the yard a space where children are not allowed. LPAs advised Licensee to have 100% supervision when children are playing near that area. Licensee stated children only during this time do not play in that area and stay where the structure and other play items are readily available.

There are no swimming pool or other bodies of water on the premises . Applicant stated there are no firearms or ammunition stored on the premises.
Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
NAME OF LICENSING PROGRAM MANAGER: Karren Starks
NAME OF LICENSING PROGRAM ANALYST: Patsy Plancarte
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2026
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: PINA FAMILY CHILD CARE
FACILITY NUMBER: 197495241
VISIT DATE: 09/11/2026
NARRATIVE
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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/.

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

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

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

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.

1 Type B deficiency is issued. 2 Advisory Notes are issued.
A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with Licensee Angela Pina.
NAME OF LICENSING PROGRAM MANAGER: Karren Starks
NAME OF LICENSING PROGRAM ANALYST: Patsy Plancarte
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2026
LIC809 (FAS) - (06/04)
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