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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198004506
Report Date: 09/09/2026
Date Signed: 09/09/2026 02:40:00 PM

Document Has Been Signed on 09/09/2026 02:40 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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:RODRIGUEZ FAMILY CHILD CAREFACILITY NUMBER:
198004506
ADMINISTRATOR/
DIRECTOR:		RODRIGUEZ, GLORIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 766-9248
CITY:LOS ANGELESSTATE: CAZIP CODE:
90006
CAPACITY: 14TOTAL ENROLLED CHILDREN: 6CENSUS: 4DATE:
09/09/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:40 PM
MET WITH:Licensee Gloria RodriguezTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On Wednesday, September 9th, 2026, at 12:40 p.m., Licensing Program Analyst (LPA) C. Nguyen conducted an unannounced annual inspection and met with licensee Gloria Rodriguez, whom the purpose of the visit was explained, and guided LPA on a tour of the facility. Licensee speaks Spanish and licensee’s assistant, Daughter, assisted with translation. Entrance Checklist LIC 126 was provided. Licensee states that there are 6 children enrolled. LPA observed 3 children and facility to be within ratio. Licensee stated operating hours are Monday to Friday from 7am - 6pm.

This is one-story home within a duplex which consists of 3 bedrooms, 2 bathrooms, kitchen, living room, den, back house (same address), front yard and backyard (fenced). Family members residing and visiting in the home were discussed (criminal record clearances on file) and names listed on form Confidential Names LIC811. The LPA toured all areas used by children during this visit. For ill isolation, licensee stated that an area in the den is utilized and always separate from other children while they wait for parents for pick up. LPA observed the first aid kit on the premises.
Areas accessible to children: den, bathroom’s den, 1 bedroom (napping), and backyard (fenced).
Areas inaccessible to children: 2 bedrooms, 1 bathroom, kitchen (sliding screen and door), back house, and front yard.

LPA observed the following required postings in the den’s entryway of the facility: License, LIC 9148 Earthquake Preparedness Checklist, LIC 610A Emergency Disaster Plan, Pub 394 Notification of Parents Rights, and LIC 999 Facility Sketch.
PAGE 1 OF 4
Katrina Chicote
Caroline Nguyen
DATE: 09/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 6
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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 198004506
VISIT DATE: 09/09/2026
NARRATIVE
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LPA inspected the facility for safety, comfort, cleanliness, ventilation and working cell phone and landline. For ventilation, LPA observed heating, AC wall units, and ceiling fans. At 12:50 p.m., Licensee began the tour starting with the outdoor side entrance of the facility where parents and children enter from. Then LPA inspected the den (main care area) and observed children’s furniture (tables/chairs), manipulatives, books, toys, puzzles, art materials and other age-appropriate materials that were well maintained and free of loose, sharp, and pointed parts. There are also cubbies for children to store their personal belongings. LPA also observed a playpen in the den and highchairs which licensee states are only used during eating for younger children. There is a diaper changing table in the den area. Napping equipment in the form of mats were observed, and licensee states they wash the linen at her facility every Friday. Then the napping room was inspected which had 3 playpens, each with tight-fitted sheets and no loose articles and Licensee stated that they are only utilized if she has infants or younger children.

LPA entered the den’s bathroom and observed a working toilet and sink with hand soap. LPA reminded licensee and personal items (ex; shampoo, toothpaste, mouthwash, or items that fall into that category) must be made inaccessible to children. There is a laundry area in the restroom and did not observe any hazardous items.

LPA inspected the kitchen which is inaccessible to the children via glass sliding door. Cleaning compound items were observed to be stored underneath the kitchen sink with a childproof lock in place, making it inaccessible for children to open. LPA observed the knives and sharp objects stored inside a drawer licensee the kitchen is inaccessible to the children. Licensee stated the facility provides breakfast, lunch, and snack and children eat in the den area. LPA informed licensee that any food brought from the children's homes, shall have the container labeled with the child's name and properly stored or refrigerated. Licensee stated that there are no children with severe food allergies nor on medication.

Currently, children are using the backyard for outdoor play time and were observed to be fenced around the perimeter and side gates closed with an operable lock at 1:00 p.m. There are extra gates fencing off the side gates. LPA observed toys, play structure, play house, arts/crafts, tables/chairs, and all play equipment is age-appropriate and in safe condition (free of sharp, loose, or pointed parts). There is also adequate shading via canopies. The backhouse is inaccessible to children in care and licensee states there is 100% supervision from either herself and assistant.

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NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Caroline Nguyen
LICENSING PROGRAM ANALYST SIGNATURE:

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

DATE: 09/09/2026
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 198004506
VISIT DATE: 09/09/2026
NARRATIVE
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LPA asked the licensee if there were any pets, poisons, firearms, or weapons, or bodies of water. Licensee stated they do not have any of above-mentioned and LPA did not observe any. The licensee was informed that if any poisons (ex; drano, rat poison or items that fall into that category), firearms and weapons are purchased, it is required to be locked with a key or combination lock and firearm and ammunition must be stored separately. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

At time of inspection, LPA observed the fire extinguisher located in the kitchen and the valve on the green area indicating fully charged and last serviced on 11/06/2025. Per State Fire Marshall standards, fire extinguishers shall be serviced or purchased with receipt annually. LPA informed licensee disaster drills shall be conducted every 6 months and LPA observed the last emergency drill conducted on 8/12/2026. LPA observed Licensee’s Assistant test a carbon monoxide detector and smoke alarm located in the kitchen/hallway, and were operable.

LPA observed licensee’s American Red Cross Pediatric First Aid/ CPR certification and expires 07/10/2028, and has proof of immunization against Pertussis, MMR, and Influenza declination. Licensee has completed the Child Abuse Mandated Reporter (AB 1207) training and expires 07/25/2027. Licensee was advised that the Pediatric First Aid/ CPR certification and mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com.

LPA also reviewed children’s roster, children files, and licensee/assistant files. LPA observed the files to be complete.

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.

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-andresources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for and removing


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NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Caroline Nguyen
LICENSING PROGRAM ANALYST SIGNATURE:

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

DATE: 09/09/2026
LIC809 (FAS) - (06/04)
Page: 5 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 198004506
VISIT DATE: 09/09/2026
NARRATIVE
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 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. LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, trampolines, Saucer Chairs, and/or any other item that fall into these categories are not permitted in a family child care facility.

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/.

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.

Licensee was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B. The On-Duty Worker is available for questions Monday through Friday at (323) 981-3350 from 8:00 AM - 5:00 PM.

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

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.

The Notice of Site Visit (LIC 9213) – A notice of site visit was given and must remain posted for 30 days.


Appeal Rights provided to licensee. Exit interview conducted and report was reviewed with the licensee Gloria Rodriguez.
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NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Caroline Nguyen
LICENSING PROGRAM ANALYST SIGNATURE:

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

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