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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016807
Report Date: 04/18/2025
Date Signed: 04/18/2025 12:30:19 PM

Document Has Been Signed on 04/18/2025 12:30 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:SHEROUSE FAMILY CHILD CAREFACILITY NUMBER:
198016807
ADMINISTRATOR/
DIRECTOR:		SHEROUSE, CRISTALFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 515-7160
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
04/18/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:29 AM
MET WITH:Licensee CristalTIME VISIT/
INSPECTION COMPLETED:
12:37 PM
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Licensing Program Analysts (LPA) Tyler Reyes and Ashley Calderon conducted an unannounced Annual/Random inspection at the above facility. LPAs met with Licensee Sherouse, Cristal and provided an Entrance Checklist-Family Child Care Homes LIC 126. LPAs conducted a tour of the facility led by Licensee Cristal. LPAs observed (11) children in care during inspection. Per Licensee there are (15) children currently enrolled. Per Licensee Cristal hours of operation are (7) days a week (24hrs) care. LPAs discussed with Licensee that children can only be in care of total of (23hrs). The licensee is approved to care for Max. Cap (when there is an assistant present): 12-No more than 4 infants. Cap 14 -No more than 3 infants. 1 child in Kindergarten or Elementary School and 1 child at least age 6.

During the inspection, the following individuals were present in the home: Licensee, Staff 1, and Staff 2. Any individuals residing in home have been discussed and noted. All adults present in the home have obtained a criminal or exemption.

Facility Postings: LPAs observed the required posting in the dining room Facility License, PUB 394 Notification of Parents’ Rights, LIC 9148 Earthquake Preparedness, and LIC 610A Emergency Disaster Plan.

Pediatric CPR/First Aid in Pediatrics Certification:

1. Licensee Date Completed 2023-09-12

2. Staff 2 Date Completed 2023-09-12

3. Staff 3 Date Completed 2023-09-12

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Tyler Reyes
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2025
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: SHEROUSE FAMILY CHILD CARE
FACILITY NUMBER: 198016807
VISIT DATE: 04/18/2025
NARRATIVE
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Emergency Disaster Drill: Fire Drill conducted on 3/19/25 at 11:30AM

Facility Sketch: The facility is a single-story structure that consists of a front yard, living room, dinning room, den, (2) restrooms, (4) bedrooms, kitchen, attached garage, (2) storage sheds, and fenced backyard.

On-Limits areas: dining room, den, kitchen, and (1) restroom.

Effective today 4/18/25, the licensee stated that the backyard will now be on-limits. LPAs toured the backyard and observed no safety hazards. The licensee provided an updated facility sketch for the file. Portions of the backyard will remain off-limits include driveway, side yard, and (2) storage sheds. LPAs informed the licensee that any future changes to on-limit or off-limit areas must be reported and approved by the Department prior to change.

Off-Limits area: living room, (4) bedrooms, (1) restroom, attached garage, driveway, and side yard.

Infants: LPAs observed (1) infant in care. Napping equipment was observed, including (2) play yards, each equipped with a mattress and fitted sheet. The infant sleep log was reviewed, which included the date, infant’s name, and the time of each 15-minute check. The LIC 9227 Individual Sleep Plan was also reviewed for infant up to 12 months of age. Per Licensee all sheets and blankets are washed in the facility once a week on Friday and as needed.

Meals: Per Licensee, children will have meals in dining room. Licensee will provide meals for children. The Licensee was advised to ensure all food brought from home is properly labeled and stored. LPAs observed (2) children files with allergies to milk. Per Licensee she purchases (5) different types of milk and presents alternatives to milk. Licensee sates it is her responsibility to prepare the children’s meals. Per Licensee staff are notified of children’s allergies.

Medication: Per Licensee the facility will provide incidental medical services. If required, medication will be stored in locked kitchen cabinet centrally stored and inaccessible to children. Medications will be administered in accordance with PIN 22-02-CCP, which outlines requirements for proper storage, documentation, and staff training. Personal medication is centrally stored in off-limits restroom and inaccessible to children in care. No children receiving medication.

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Tyler Reyes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2025
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: SHEROUSE FAMILY CHILD CARE
FACILITY NUMBER: 198016807
VISIT DATE: 04/18/2025
NARRATIVE
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The following on-limit areas that will be used by children were inspected for safety, comfort, and cleanliness. LPAs observed age-appropriate toys and learning materials. Telephone service is provided via cell phone. The facility provides heating and cooling through central air system. LPAs observed a 2A10BC fire extinguisher located in the kitchen with a service date Feb 12th 2024 and overcharged. The current condition of the fire extinguisher poses a potential health and safety risk to children in care. LPAs informed Licensee Per Title 22 the home shall contain a fire extinguisher which meet standards established by the State Fire Marshall. The home has an operable smoke alarm in hallway and carbon monoxide detector located in the den. Isolation area for sick children is in the kitchen.

Per Licensee there is no poisons kept in the home. LPAs informed that all poisons need to be kept centrally stored and key locked from children in care. Cleaning products are centrally stored in kitchen and secured with a childproof latch. Sharps are stored in a cabinet above the fridge. There are no personal hygiene supplies accessible to children in the restroom. There are no firearms on the premises. If firearms are present, LPAs verified per Title 22 regulations that they are locked, with ammunition stored separately. LPAs observed facility has childproof electrical outlet covers. No bodies of water were observed. Per licensee no pets are present at the facility. The fireplace has been blocked and is located in off-limit room.

Outdoor: The outdoor play area was observed to be fenced. LPAs observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that could be hazardous to children in care. No animal feces were observed. There are no pools or spas, or other bodies of water.

Staff Files: LPAs reviewed Licensee and (2) staff files which included the following documentation: LIC 9052 Employee Rights, and LIC 9108 Statement Acknowledging Requirements to Report Child Abuse. Based on record review it was observed Licensee and staff 2 (S2) did not have a current Mandated Reporting Training Certificate which poses a potential health and safety risk. Based on record review it was observed (S1) was missing proof of immunization for Measles and TB which poses a potential health and safety risk.

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Tyler Reyes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2025
LIC809 (FAS) - (06/04)
Page: 7 of 7
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: SHEROUSE FAMILY CHILD CARE
FACILITY NUMBER: 198016807
VISIT DATE: 04/18/2025
NARRATIVE
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Children Files: LPAs reviewed (3) children files, which included the following documentation: LIC 282 Affidavit Regarding Liability Insurance, LIC 700 Identification and Emergency Information, LIC 627 Consent for Emergency Medical Treatment, and LIC 995A Notification of Parents’ Rights. (3) of (3) children had the required documentation.

· 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 toinspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website atwww.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.
· 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.
· 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.

A notice of site visit was given and must remain posted for 30 days consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. Exit interview conducted and Appeal Rights provided with Licensee Cristal Please see attached LIC 809-D for citations. (3) Type B's will be issued today.

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Tyler Reyes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2025
LIC809 (FAS) - (06/04)
Page: 3 of 7
Document Has Been Signed on 04/18/2025 12:30 PM - It Cannot Be Edited


Created By: Tyler Reyes On 04/18/2025 at 11:56 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: SHEROUSE FAMILY CHILD CARE
FACILITY NUMBER: 198016807

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/18/2025

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 observations the licensee did not comply with the section cited above fire extinguisher is overcharged and does not has an expired service tag attached which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/25/2025
Plan of Correction
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Licensee will ensure fire-extinguisher is serviced yearly. Licensee will provide proof of fire-extinguisher is serviced with service tag and arrow indicator in the green. Licensee will provide proof via email by POC Due Date.
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
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Based on record review, the licensee did not comply with the section cited above Licensee and staff 2 (S2) did not have a current Mandated Reporting Training Certificate] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/25/2025
Plan of Correction
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Licensee will esnure all employees have a current Mandated Reporter Certifciate on file. Licensee will provide proof of a current Mandated Reporter Certificate for Licensee and Staff 2 (S2) by POC Due Date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Karen Chambers
NAME OF LICENSING PROGRAM MANAGER:
Tyler Reyes
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2025


LIC809 (FAS) - (06/04)
Page: 4 of 7
Document Has Been Signed on 04/18/2025 12:30 PM - It Cannot Be Edited


Created By: Tyler Reyes On 04/18/2025 at 11:56 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: SHEROUSE FAMILY CHILD CARE
FACILITY NUMBER: 198016807

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/18/2025

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 record review , the licensee did not comply with the section cited above Staff 1(S1) was missing proof of immunization for Measles and TB which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/25/2025
Plan of Correction
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Licensee will ensure all employee are current and proof of immunizations on file. Licensee will provide proof of Staff 1 (S1) immunizations Measles and TB 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.
Karen Chambers
NAME OF LICENSING PROGRAM MANAGER:
Tyler Reyes
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2025


LIC809 (FAS) - (06/04)
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