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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198002649
Report Date: 09/26/2025
Date Signed: 09/26/2025 03:38:59 PM

Document Has Been Signed on 09/26/2025 03:38 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:RANDALL/CYPHERS FAMILY CHILD CAREFACILITY NUMBER:
198002649
ADMINISTRATOR/
DIRECTOR:		CARNETTA AND MICHAELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 354-8921
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
09/26/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:33 PM
MET WITH:LICENSEE/ CARNETTA RANDALL/CYPHERS TIME VISIT/
INSPECTION COMPLETED:
03:40 PM
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Licensing Program Analysts (LPA) Ashley Calderon conducted an unannounced annual / random inspection at the above facility on 9/26/25 at 12:33pm. LPA met with Facility Representative Kristiona Garnett Brown who allowed LPA entrance into the facility. LPA disclosed purpose of today's visit.

There were 4 children present, 2 whom were infants with assistant. Garnett Brown guided analyst on a tour of the facility. Facility capacity is in compliance for a Large Family Child Care Home. Hours of operation are Mon-Fri 6:00 AM - 6:00PM.

This is a one story home which consists of 4 bedrooms, 2 bathrooms, kitchen, den, dining room, living room, garage and backyard (fenced). The children use the front bathroom, living room, and backyard (split in two part and divided by a gate). Change of off limits from 4 bedrooms to 3 that are off limit were addressed on today's date. Per licensee, areas off limits to children and parents include: 3 bedrooms, part of the backyard and garage. The LPA toured all areas used by children during this visit.

Family members residing in the home are three adults who have clearances on file.
Individuals residing in the home have been discussed and noted. All adults present in the home have obtained a criminal record clearance or exemption.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection:
LPA reviewed required posted documentations located in living room for: Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. Facility records were reviewed for LIC 9040- Facility Roster. Pg.1
NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2025
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: RANDALL/CYPHERS FAMILY CHILD CARE
FACILITY NUMBER: 198002649
VISIT DATE: 09/26/2025
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At 12:35pm LPA Calderon observed in living room 2 infants, both infants, Child #1 and Child #2 were sleeping in the incline baby swing/ soother,picture taken, deficiency cited. LPA observed a car seat in the living room and LPA reminded assistant to use car seats for transportation only. LPA informed assistant transfer infants to a play yard or crib immediately when sleeping elsewhere besides play yards or cribs. At 12:51pm Staff Assistant transferred Child #1 and Child #2 to a play yard in a bedroom that is identified as an off limit room and at 1:12pm Licensee Carnetta Chyphers arrived at the facility during interview stated made a bedroom an infant room during the summer, deficiency cited. LPA informed Staff Assistant and Licensee Carnetta Chyphers Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care. Child #1 was transferred to a play yard and at 12:51pm was placed in play yard with a pacifier that had an attachment, child was awake , picture was taken and consultation was given, when sleeping in a play yard no pacifier with an attachment is allowed when sleeping . Infants, Child #1 and Child #2 were placed in play yards, observed to have no mattress and no fitted sheets in play yard, picture taken, deficiency cited.

Den was observed to have a fireplace observed barricaded screened for inaccessibility.

Food is provided by Licensee for some children and some children are on special diets and they bring their food from home. Licensee was reminded if children bring food from home it must be labeled with the child’s name and properly stored or refrigerated. Knives are made inaccessible stored in kitchen.

Fire extinguisher was observed 2A10BC with service tag March 15,2025, deficiency cited. Carbon monoxide and smoke alarm weren't tested due to napping children. Fire/Disaster drill was logged for last conducted on Sept 9/2025. .

LPA informed Licensee C.Chyphers Licensee's temporary absence should not exceed 80% of the hours of operation. Per Licensee C.Chyphers stated there are no weapons and firearms stored in this home.


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NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2025
LIC809 (FAS) - (06/04)
Page: 3 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: RANDALL/CYPHERS FAMILY CHILD CARE
FACILITY NUMBER: 198002649
VISIT DATE: 09/26/2025
NARRATIVE
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Currently children play in the backyard. Per Licensee, children are fully supervised when they are outside. Off- limit areas of the backyard are gated off. No bodies of water observed on premises.

Children’s records were reviewed, 4 files total: for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment and, LIC 995A Notification of Parents’ Rights. Infants Child #1 and #2 had LIC9227 individual Safe Sleep plan and 15 min sleep log.

Staff records were reviewed; during record review at 1:18PM Licensees Michael and Carnetta Chyphers Pediatric first aid and cpr expires 10/01/25. At 1:26pm staff assistant present Garnett Brown first aid and cpr was reviewed, LPA reviewed document that states Basic Live Support (BLS) CPR and AED from American Heart Association, document does not met regulation, LPA Calderon observed staff assistant was left with 4 children from the time LPA arrived at 12:33pm until Licensee Carnetta Chyphers arrived at 1:12pm, deficiency cited. Mandated Reporter training for Licensees Michael Chyphers expires 4/26/26 and Carnetta Chyphers certificate expires 4/26/26. At 2:37pm additional children (school age) arrived at the facility, making census 6.
  • 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.
  • 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. Pg.3
NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2025
LIC809 (FAS) - (06/04)
Page: 4 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: RANDALL/CYPHERS FAMILY CHILD CARE
FACILITY NUMBER: 198002649
VISIT DATE: 09/26/2025
NARRATIVE
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  • 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 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.
  • This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.
  • 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.

During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. Based on today’s visit, Per California Code of Regulation Title 22 there were deficiencies cited on todays visit, provided on LIC 809-D. Type A and Type B's.

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 dated 9/26/25 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

A notice of site visit was given and must remain posted for 30 days and appeal rights provided. Exit interview conducted and report was reviewed with the licensee Carnetta Cyphers.



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NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2025
LIC809 (FAS) - (06/04)
Page: 5 of 9
Document Has Been Signed on 09/26/2025 03:38 PM - It Cannot Be Edited


Created By: Ashley Calderon On 09/26/2025 at 03:05 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: RANDALL/CYPHERS FAMILY CHILD CARE
FACILITY NUMBER: 198002649

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(d)
Operation of A Family Child Care Home
(d) The home shall provide safe toys, play equipment and materials.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on At 12:35pm LPA Calderon observed in living room 2 infants, both infants, Child #1 and Child #2 were sleeping in the incline baby swing/ soother,picture taken, deficiency cited, the licensee did not comply with the section cited above in [2] out of [2] infant sleeping incline baby swing/ soothewhich poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/27/2025
Plan of Correction
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Per Licensee will revmove soothers and Will send a text on the plan of removing items to LPA Caldeorn by poc due date of 9/27/25
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.
Denise Gibbs
NAME OF LICENSING PROGRAM MANAGER:
Ashley Calderon
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2025


LIC809 (FAS) - (06/04)
Page: 6 of 9
Document Has Been Signed on 09/26/2025 03:38 PM - It Cannot Be Edited


Created By: Ashley Calderon On 09/26/2025 at 03:05 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: RANDALL/CYPHERS FAMILY CHILD CARE
FACILITY NUMBER: 198002649

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on Fire extinguisher was observed 2A10BC with service tag March 15,2025, the licensee did not comply with the section cited above in [1] out of [1] fire extinguisher does not met Fire Marshall Regs which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/10/2025
Plan of Correction
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Licensee stated Fire extinguisher will get services and snd picture to LPA Calderon by due date 10/10/25.
Type B
Section Cited
CCR
102425(a)(3)
Infant Safe Sleep
(a) There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. (3) Mattresses shall be firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the mattress so it cannot be dislodged.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA Calderon observation Child #1 and Child #2, infants placed in play yards with no firm mattress or fitted sheets, the licensee did not comply with the section cited above in [1) out of [1] play ayrd with no mattress which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/10/2025
Plan of Correction
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Licensee will send pictures of the play yards with firm mattress and fitted sheet by poc due date 10/10/25.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Denise Gibbs
NAME OF LICENSING PROGRAM MANAGER:
Ashley Calderon
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2025


LIC809 (FAS) - (06/04)
Page: 7 of 9
Document Has Been Signed on 09/26/2025 03:38 PM - It Cannot Be Edited


Created By: Ashley Calderon On 09/26/2025 at 03:05 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: RANDALL/CYPHERS FAMILY CHILD CARE
FACILITY NUMBER: 198002649

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA Calderon record review: at 1:26pm staff assistant present Garnett Brown first aid and cpr was reviewed, LPA reviewed document that states Basic Live Support (BLS) CPR and AED from American Heart Association, document does not met regulation, LPA Calderon observed staff assistant was left with 4 children from the time LPA arrived at 12:33pm until Licensee Carnetta Chyphers arrived at 1:12pm, , the licensee did not comply with the section cited above in [1] out of [1] not a valid pediatric first aid and cpr which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/17/2025
Plan of Correction
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Per Licensee will have staff assistant take pediatric 1st aid and cpr class and send certficate to LPA Calderon by poc due date,.
Type B
Section Cited
CCR
102416.3(a)(6)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (6) Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA Calderon observation t 12:51pm Staff Assistant transferred Child #1 and Child #2 to a play yard in a bedroom that is identified as an off limit room and at 1:12pm Licensee Carnetta Chyphers arrived at the facility during interview stated made a bedroom an infant room during the summer,the licensee did not comply with the section cited above in [1] out of [1] off limit area being used which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/10/2025
Plan of Correction
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Licensee will send updated Facility Sketch to LPA Calderon by poc due date to LPA Calderons email.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Denise Gibbs
NAME OF LICENSING PROGRAM MANAGER:
Ashley Calderon
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2025


LIC809 (FAS) - (06/04)
Page: 8 of 9
Document Has Been Signed on 09/26/2025 03:38 PM - It Cannot Be Edited


Created By: Ashley Calderon On 09/26/2025 at 03:05 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: RANDALL/CYPHERS FAMILY CHILD CARE
FACILITY NUMBER: 198002649

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2025

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
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Based on Staff Assistant file during record review had no immunization records, the licensee did not comply with the section cited above in [1] out of [3] staff records which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/17/2025
Plan of Correction
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Staff Assistant will provide Licensee with immunization records. TB (current), MMR, flu vax or decline letter, and TDAP or DTAP and send records to LPA Calderon by poc due date.
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.
Denise Gibbs
NAME OF LICENSING PROGRAM MANAGER:
Ashley Calderon
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2025


LIC809 (FAS) - (06/04)
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