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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198009572
Report Date: 12/10/2025
Date Signed: 12/10/2025 03:04:52 PM

Document Has Been Signed on 12/10/2025 03:04 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:VALDEZ FAMILY CHILD CAREFACILITY NUMBER:
198009572
ADMINISTRATOR/
DIRECTOR:		VALDEZ, COLUMBAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 714-0991
CITY:PARAMOUNTSTATE: CAZIP CODE:
90723
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
12/10/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Columba Valdez, LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Alicia Mooberry conducted an unannounced Annual Random Inspection in Spanish on this date. Upon arrival at 1:00pm and LPA met with Columba Valdez, informed of the purpose of inspection and provided form LIC 126, Inspection Entrance Checklist. The Licensee provided tour of facility. LPA inspected rooms/areas on the facility sketch in which child-care services are provided and to which children have access. Per licensee the current hours of care provided are Monday – Friday 5:00am - 6:00pm. The licensee offers overnight care, between the hours of 6 p.m. and 6 a.m. LPA discussed with provider that care provided during the day and overnight combined shall not exceed 24 hours from the time the child entered care per Tittle 22 regulations 104425. There were 5 children present, including 1 infant. LPA discussed individuals residing in the home. All adults reported by licensee to reside in the home have obtained the required background clearance and are associated to the facility.

This is a single story home consists of 4 bedrooms and 2 baths, kitchen, large living room (Daycare area), laundry room, attached garage.

The areas accessible to children include: Kitchen, Daycare Room, bathroom and backyard.

Off limit areas: 4 bedrooms, 1 bath, garage, side yard (used as dog run).


All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness.
LPA observed the facility license and Publication (PUB) 394- Notification of Parent Rights posted outside the home by entrance and Licensing Form (LIC) 9148- Earthquake Preparedness form posted by entrance. LPA reviewed current and complete Children’s Roster form LIC 9040 and Emergency Disaster Plan (LIC 610A). LPA advised licensee to maintain documents updated. ---------Page 1 – Report Continues
NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Alicia Mooberry
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2025
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: VALDEZ FAMILY CHILD CARE
FACILITY NUMBER: 198009572
VISIT DATE: 12/10/2025
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The home is observed to be clean and orderly. Smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher indicated fully charged and was serviced on 8/25/25. The home maintains telephone service via cell phone.
LPA observed age appropriate and safe toys and material available. Cleaning compounds are located in kitchen under the sink cabinets with safety locks. The bathroom that children use is in the hallway by bedroom and observed to be clean and free of hazards, cleaning agents in spray bottle were observed in under sink cabinets secured with safety lock. Licensee states that there are no poisons stored in the home and understands that all poisons must be locked, not only inaccessible to children.

Per Licensee there are no firearms or weapons stored in the home Per Licensee, area for sick children waiting to be picked up is in the daycare room, supervised and away from the other children.


Currently, children are using the back yard for outdoor play. The outdoor play area located in the backyard, was observed to be fenced with toys and other materials for children to play with. LPA observed an Air-conditioning unit in the backyard that is kept with a cover while children are outside playing. LPA did not observe any hazards in the yard. Per licensee, there are currently no animals kept in the home

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, and documentation of 15-minute Infant Sleep Check (0-24 months). One out of 5 children present did not have a facility file, posing a potential risk to the health and safety of children in care.


Upon arrival at 1:00pm LPA observed Child #1 infant of 5 months laying on a sleeping mat on the floor, per licensee, a play yard will be obtained prior to Child #1's return to daycare. Per licensee child #1, age 5 months started on this date and parent will bring completed file upon pick up.

Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunizations 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.

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. -------Page 2, report continues

NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Alicia Mooberry
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2025
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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: VALDEZ FAMILY CHILD CARE
FACILITY NUMBER: 198009572
VISIT DATE: 12/10/2025
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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.

Licensee facility 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.

There is 1 infant under 12 months of age currently enrolled. LPA provided a sample sleep log and LIC 9227 to licensee, per request. LPA observed observed infant does not have a crib or play yard available for napping, posing a potential risk. 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 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. LPA discussed and provided PIN 22-01-CCLD -Requirement for individuals that are currently associated to the facility maintain current mailing address with the department. LPA pro

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 the LPA's observations and records review 2 B deficiencies will be cited today in accordance with California Title 22 Regulations. A notice of site visit was given and must remain posted for 30 days. Appeal Rights were discussed and provided. Exit interview conducted and report was reviewed with the licensee Columba Valdez. Appeal Rights were discussed and provided

NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Alicia Mooberry
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/10/2025 03:04 PM - It Cannot Be Edited


Created By: Alicia Mooberry On 12/10/2025 at 02:47 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: VALDEZ FAMILY CHILD CARE
FACILITY NUMBER: 198009572

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/10/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(a)
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.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in that 1 out 1 infant (age 5 months) did not have a crib or play yard available for napping which posesd a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/11/2025
Plan of Correction
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Per licensee, a play yard will be obtained and available for Infant prior to the next time they are present in daycare. A photo of the play yard as proof of purchase will be sent to LPA by POC due date.
Type B
Section Cited
CCR
102418(a)
Immunizations
(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in that 1 out of 4 children's files reviewed did not have immunization record which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/17/2025
Plan of Correction
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Per licensee, the immunzation record for child #1 wil be obtained by POC due date 12/17/25, A subsequent visit will be conducted to review file for Child #1.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Warren Birks
NAME OF LICENSING PROGRAM MANAGER:
Alicia Mooberry
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/10/2025


LIC809 (FAS) - (06/04)
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