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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198013441
Report Date: 08/20/2026
Date Signed: 08/20/2026 12:09:50 PM

Document Has Been Signed on 08/20/2026 12:09 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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:HAYES FAMILY CHILD CAREFACILITY NUMBER:
198013441
ADMINISTRATOR/
DIRECTOR:		HAYES, PRISCILLAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 357-3852
CITY:MONROVIASTATE: CAZIP CODE:
91016
CAPACITY: 14TOTAL ENROLLED CHILDREN: 13CENSUS: 1DATE:
08/20/2026
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:Licensee Priscilla HayesTIME VISIT/
INSPECTION COMPLETED:
12:20 PM
NARRATIVE
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Licensing Program Analyst (LPAs) Cynthia Reyes and Stephanie Li conducted an unannounced plan of correction (POC) in English. Upon arrival LPAs met with licensee Priscilla Hayes to whom the reasons for the inspection was explained. This inspection is to ensure the health and safety standards as required by the regulations governing childcare homes are met.

LPAs observed the following citations listed below have been corrected:
Fire extinguisher (Date of receipt 08/06/2026)
Mandated reporter certificate for licensee (Date Exp, 10/27/2026) and Asst.(Date Exp, 11/04/2026)

Letter of Deficiency Citations Cleared was provided for the deficiencies corrected.

LPA observed the following citations listed below have not been corrected:
Assistant Immunization's (Missing Tdap)
Assistant CPR and First Aid (None) Licensee (Exp 08/01/2026)
Proof of child's file (Missing second page with parent signature and date for forms Identification and Emergency and the Individual sleep plan)

Citations listed above are being recited on the 809D pages and need to be corrected by the new plan of correction (POC) date.
Christina Gabelman
Cynthia Reyes
DATE: 08/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/20/2026
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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: HAYES FAMILY CHILD CARE
FACILITY NUMBER: 198013441
VISIT DATE: 08/20/2026
NARRATIVE
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LPAs consulted and gave detailed instructions with the licensee regarding the children roster as well as other documents having the parent signature and date on all forms required. LPAs also spoke with licensee regarding understanding state laws and regulations and how they can change each year and that it is her responsibility to know what has changed or not. LPA printed copies of the children's roster and licensee updated the roster during this inspection.

Exit interview conducted and report was reviewed with Licensee Priscilla Hayes,

Notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100

NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Cynthia Reyes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2026
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 08/20/2026 12:09 PM - It Cannot Be Edited


Created By: Cynthia Reyes On 08/20/2026 at 11:20 AM
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: HAYES FAMILY CHILD CARE
FACILITY NUMBER: 198013441

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/20/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/28/2026
Section Cited
HSC
1597.622(c)

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(c) The family day care home shall maintain documentation of the required immunization's or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home. This requirement is not met as evidenced
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Licensee states she will provide proof by the POC date of 08/28/2026.
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by: Licensee has not provided proof of her assistants Immunization (TDAP) since the last inspection dated 06/25/2026 which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
08/28/2026
Section Cited
CCR102417(g)(7)

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(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization
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Licensee states she will provide proof by the POC date of 08/28/2026.
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for the licensee. This requirement is not met as evidenced by: Licensee has not provided proof on the child's second page with parent signature and date for forms Identification and Emergency and the Individual sleep plan from visit of 06/25/2026 which poses/posed a potential 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.
Christina Gabelman
NAME OF LICENSING PROGRAM MANAGER:
Cynthia Reyes
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/20/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/20/2026


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 08/20/2026 12:09 PM - It Cannot Be Edited


Created By: Cynthia Reyes On 08/20/2026 at 11:35 AM
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: HAYES FAMILY CHILD CARE
FACILITY NUMBER: 198013441

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/20/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/25/2026
Section Cited
CCR
102416.1(a)(6)

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(a) Personnel records shall be maintained on each employee and shall contain the following information: (6) Documentation of completion of training on preventative health practices as required by Section 102416(c).This requirement is not met as evidenced by: Licensee has not provided
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Licensee states will send proof for her and her assistant pediatric CPR and First Aid by the POC date of 09/25/2026.
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proof of her assistant and now licensee expired pediatric CPR and First Aid since the last inspection dated 06/25/2026 which poses/posed a potential health, safety or personal rights risk to children 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.
Christina Gabelman
NAME OF LICENSING PROGRAM MANAGER:
Cynthia Reyes
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/20/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/20/2026


LIC809 (FAS) - (06/04)
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