198012488-12-11-2025-54-CC-DCHS-DP9U6R-20251211141848

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198012488
Report Date: 12/11/2025
Date Signed: 12/11/2025 02:19:45 PM

Document Has Been Signed on 12/11/2025 02:19 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:	COOK FAMILY CHILD CARE		FACILITY NUMBER:	198012488
ADMINISTRATOR/ DIRECTOR:	COOK, AMBER		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 701-3931
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90806
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 4	DATE:	12/11/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:30 AM
MET WITH:	Maria Del Socorro, Assistant		TIME VISIT/ INSPECTION COMPLETED:	03:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts (LPAs) Dayna Chambers and Alicia Mooberry conducted an unannounced annual inspection to the above facility on 12/11/2025. LPAs arrived at the facility at 9:30am, identified self, and met with Maria Sandoval, assistant, who guided analyst on a tour of the facility. Licensee, Amber Cook, arrived approximately at 10:00am. LPA provided Licensee with a copy of the LIC 126 Entrance Checklist to help facilitate the inspection. Per Licensee, they currently have two assistants. LPA observed 4 children upon arrival. There are 5 children that are currently enrolled. The current LIC9040 children’s roster was available for review. Per Licensee, operation hours are Monday through Friday 7:00am to 6:00PM. Individuals who reside in the home were noted and discussed. This is a one-story home which consists of 3 bedrooms, 2 bathrooms, kitchen, dining room, Den, Activity Room connected to back area, living room, garage is converted into activity area, front yard, and backyard (fenced). The children use the bathroom in the hallway. Per Licensee, areas off limits to children and parents include: all bedrooms, master bathroom, living room. Children use the following: The dining room, bathroom in hallway, activity room behind home, and activity space in garage. The restroom that children use was observed to be safe and sanitary. Currently, children are using the back yard for outdoor play time. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that could pose a danger to children in the outdoor yard. Upon arrival, LPAs observed baby bouncer and infant walker in the activity room (photos taken). LPAs advised assistant and licensee to remove the bouncer and infant walker from the premises. LPAs provided licensee with PIN 19-16 Consumers not to use Inclines. Safe toys play equipment and materials were observed. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. LPAs

NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Dayna Chambers
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/11/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025

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: COOK FAMILY CHILD CARE	FACILITY NUMBER: 198012488
	VISIT DATE: 12/11/2025

NARRATIVE

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observed dusty floors, dirt and spider webs on outside toys, and in activity room in garage and inside activity room. LPAs advised licensee regarding areas to be clean and orderly for daycare children. LPAs observed steps in activity room and advised the licensee to install corner guards on the edges of steps as a best practice. LPAs advised licensee to check all children’s equipment for recalls on the United States consumer product safety commission and/or internet search. LPAs observed the disk heater in the activity room and advised the licensee to place higher up from children’s area for safety. LPAs observed the daycare door had peeling paint that needs to be repaired. LPA was advised to3 bedrooms, 1 bathroom, Den, living room, and front yard. The licensee provides food for children in care. Licensee states that there are no firearms stored in the home. Per licensee, there is one small cat that is inaccessible to children in car during daycare hours. LPA did not observe any pools, spas, hot tubs, fishponds, or similar bodies of water during the inspection. There is telephone service via cellphone, and the cellphone stays at the facility during operation hours. There is ventilation and heating via fans and central heat and air. Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 10/22/2024, as indicated on service tag. The fire extinguisher receipt has expired since 10/22/2025. Smoke and carbon monoxide detectors were tested and are operable. Licensee states that she is currently caring for infants. Licensee states that infants sleep in the activity room where they are constantly supervised. Appropriate sleeping arrangements and cribs were observed. (One crib for each infant in care was observed. Cribs or play yard did not hinder the entrance or exit from the sleeping space, mattresses shall be firm and covered with a fitted sheet that overlaps the underside so it cannot be dislodged. Cribs and play yards were observed to be free of loose articles and objects. No objects were observed to be hanging above or attached to the side of the crib. LPA did not observe any infants swaddled while in care. Infants shall be checked every 15 minutes, and the time of each 15-minute check shall be documented with child’s name and date. LPAs observed the sleep charts were not filled out currently. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age. The licensee is observed to be operating within the license capacity limitations. The licensee does not provide transportation. The licensee and other personnel training on preventive health practices including Pediatric First Aid and CPR was expired and not EMSA approved Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expired on 10/21/2025 and was also not EMSA approved training. There are first aid supplies available. LPA advised that if a child shows signs of illness, he/she/they shall be separated from other children. Children’s records were reviewed, including emergency information and were

NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Dayna Chambers
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/11/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025

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: COOK FAMILY CHILD CARE	FACILITY NUMBER: 198012488
	VISIT DATE: 12/11/2025

NARRATIVE

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observed to be complete. The licensee and assistants are missing MMR records in the files. Assistant #2 has complete immunization record, proof of immunizations against MMR (Mumps, Measles, Rubeola), TDAP, TB Clearance, and current influenza or declination. LPA observed that the Licensee and assistants mandated reporter expired. Assistant #1 has a valid mandated report training proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file. LPA issued a Confidential Names List (LIC 811) to the licensee which documents staff and children’s files reviewed during this inspection. All homes shall conduct fire and disaster drills at least once every six months and document the date and time of each drill. Last drill documented was conducted on 11/19/2025. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted.Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home. 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. repair the peeling areas. Off Limit Areas: Per Licensee, areas off limits to children and parents include LPA discussed the safe sleep regulations with 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 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. 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 childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California. Megan’s Law - FCCH During the exit interview, the Licensee Amber Cook, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. Closing Script- CCC and FCCH To improve the quality

NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Dayna Chambers
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/11/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025

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: COOK FAMILY CHILD CARE	FACILITY NUMBER: 198012488
	VISIT DATE: 12/11/2025

NARRATIVE

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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. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Amber Cook, Licensee. The following deficiencies listed on the attached deficiency page are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Dayna Chambers
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/11/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/11/2025 02:19 PM - It Cannot Be Edited

Created By: Dayna Chambers On 12/11/2025 at 01:44 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: COOK FAMILY CHILD CARE	FACILITY NUMBER: 198012488
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/11/2025

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
1 2 3 4	Based on observation, record review and interview, the fire extinguisher receipt dated 10/22/2025 was expired and needs to be serviced,, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/19/2025
	Plan of Correction
1 2 3 4	Licensee will service fire extinguisher or purchase a new extinguisher and save the receipt. The licensee will emaili proof o correction to the LPA by 12/19/2025.

Type B

Section Cited

CCR

102417(g)(10)

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: (10) A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code Sections 1596.846(b) and (c). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, LPA observed upon arrival a baby bouncer and baby walker in the daycare room. There were no children in the seats.the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/11/2025
	Plan of Correction
1 2 3 4	the licensee removed the infant equipment from the daycare room during inspection and was provided the PIN 19-16 CCP Consumers urged not to use inclined equipment.

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:

	Dayna Chambers
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/11/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/11/2025 02:19 PM - It Cannot Be Edited

Created By: Dayna Chambers On 12/11/2025 at 01:44 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: COOK FAMILY CHILD CARE	FACILITY NUMBER: 198012488
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/11/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, record review, the licensees Mandatated Reporter Training was expired on 04/24/2025. the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/26/2025
	Plan of Correction
1 2 3 4	Licensee will renew their Mandated Reporter Training and provide proof of correction via email by 12/26/2025

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
1 2 3 4	Based on observation and record review, two assistants and licensees CPR training is expired, in addition, the training is not the correct class for licensed child care providers and Pediatric First Aid and Cin [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/03/2026
	Plan of Correction
1 2 3 4	Licensee and Staff will renew CPR classes by 01/03/26 and take the correct EMSA Pediatric First and CPR for licensed childcare providers. Licensee will provide proof of correction by emailing LPA the correct training by 01/03/26.

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:

	Dayna Chambers
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/11/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/11/2025 02:19 PM - It Cannot Be Edited

Created By: Dayna Chambers On 12/11/2025 at 01:44 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: COOK FAMILY CHILD CARE	FACILITY NUMBER: 198012488
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/11/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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
1 2 3 4	Based on observation and file reviews, children's files were missing immunization records, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/03/2026
	Plan of Correction
1 2 3 4	Licensee will obtain missing immunization records and place in files. Licensee will show proof of correction to LPA by 01/03/26 via email.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

	Dayna Chambers
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/11/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025

LIC809 (FAS) - (06/04)

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