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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495542
Report Date: 11/19/2025
Date Signed: 11/20/2025 07:59:19 AM

Document Has Been Signed on 11/20/2025 07:59 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:JALTSAN FAMILY CHILD CAREFACILITY NUMBER:
197495542
ADMINISTRATOR/
DIRECTOR:		TUNGALAGTUYA JALTSANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 993-8834
CITY:LOS ANGELESSTATE: CAZIP CODE:
90019
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 13DATE:
11/19/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:31 PM
MET WITH:Licensee,Tungalagtuya JaltsanTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
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On 11/19/2025 Licensing Program Analyst (LPA) Brittany Lovest and LPA Judy Laureano conducted an unannounced case management deficiency inspection for the purpose of ensuring the standards are being met in accordance with California Tittle 22 Regulations and California Health and Safety Codes.

LPA Lovest and LPA Laureano were greeted by licensee. LPAs then toured the facility and observed 13 children in care with Licensee, S2 and S4. LPAs observed S3 in the kitchen preparing food for children..

LPA Laureano asked S2 for S3’s name and title and she wrote down S3's name and stated she was "the help".

S4 stated S3 was their mother and helping for the day.

LPAs reviewed the Guardian website and confirmed that staff member S3 does not have a current criminal clearance associated to the family child care home named above. The Guardian Background Check System search results provided no match/association for staff member S3 in the background checking system to the facility.

Based on record review and information obtained 1 out of 4 staff members do not have a current criminal clearance associated to the facility.

NAME OF LICENSING PROGRAM MANAGER: Loyce Phillips
NAME OF LICENSING PROGRAM ANALYST: Brittany Lovest
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2025
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: JALTSAN FAMILY CHILD CARE
FACILITY NUMBER: 197495542
VISIT DATE: 11/19/2025
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There was one deficiency A Type cited during today’s visit in accordance with the California Code of Regulations, Title 22, Division 12, and Chapter 3. See LIC 8099-D for additional information. As well as a Civil Penalty Assessment - Caregiver Background Check was given.

Effective January 1, 2009, all licensees must comply with Assembly Bill (AB) 978. Assembly Bill 978 requires the assessment of an immediate civil penalty for designated serious violations at community care facilities. Effective January 1, 2007, the licensee must comply with Assembly Bill 633 as follows: Copies of any licensing report that documents a Type A citation - this includes facility visits and substantiated complaint investigations. Copies of any licensing documents pertaining to a noncompliance conference between licensing management and licensees. Copies of a summary of an accusation indicating the Department’s intent to revoke the facility’s licenses. Copies of any of the above licensing documents the licensee has received in the prior 12 months shall be provided to parents/guardians of newly enrolling children. The licensee shall keep verification of receipt in each child’s file at the facility as proof of compliance (LIC 9224).

Upon receipt of this report, the Licensee shall post the Notice of Site Visit. The Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty.

An exit interview was conducted, and report was reviewed with Licensee. A copy of this report and appeal rights were discussed and left with Licensee whose signature on this form confirm receipt of these documents.

NAME OF LICENSING PROGRAM MANAGER: Loyce Phillips
NAME OF LICENSING PROGRAM ANALYST: Brittany Lovest
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/20/2025 07:59 AM - It Cannot Be Edited


Created By: Brittany Lovest On 11/19/2025 at 12:16 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: JALTSAN FAMILY CHILD CARE
FACILITY NUMBER: 197495542

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/20/2025
Section Cited
CCR
102370(d)(1)

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102370 Criminal Record Clearance
(d) All individuals subject to a criminal record review...shall prior to working, residing, or volunteering in a licensed facility:(1)Obtain a California clearance or a criminal record exemption as required by the Department or
This requirement is not met as evidenced by:
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Licensee agrees to have S3 criminal record cleared prior to working in facility. S3 left home during visit.
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Based on observation,interview, and record review, the licensee did not comply with the section cited above in 1 out of 4 staff present did not have a criminal record clearance, which poses/posed an immediate health, safety or personal rights risk to persons in care.
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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:
Brittany Lovest
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 11/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/19/2025


LIC809 (FAS) - (06/04)
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