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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016841
Report Date: 02/12/2026
Date Signed: 02/12/2026 10:20:24 AM

Document Has Been Signed on 02/12/2026 10:20 AM - 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:MOORE FAMILY CHILD CAREFACILITY NUMBER:
198016841
ADMINISTRATOR/
DIRECTOR:		MOORE, DONICEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 220-7683
CITY:LOS ANGELESSTATE: CAZIP CODE:
90059
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
02/12/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Licensee Donice MooreTIME VISIT/
INSPECTION COMPLETED:
10:40 AM
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Licensing Program Analyst (LPA) Peter Bishop arrived at the above facility for the purpose of an Unannounced Annual Visit at 9:40 AM. Upon arrival, LPA Bishop announced the purpose of the visit and was granted entry into the facility by Licensee Donice Moore who provided tour of facility. LPA provided the inspection Entrance Checklist, LIC 126. 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 6:00 am -- 6:00 pm at the time of inspection no overnight care is provided. There were 0 children present during today's inspection. There are 8 children currently enrolled. Licensee stated that she and her daughter are the only one that lives here, and current criminal background clearance. LPA observed the facility license, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness forms. Licensee was advised to post the required documents on the parent board.

LPA Bishop was given a tour of the facility. This is single - family home consists of three bedrooms, two bathrooms, kitchen, living/dining area and backyard. Per licensee, the areas used by children include Living Room, Bathroom 1 and outside play area. Outside play area was made inaccessible today because of the weather. Areas that are used by children were inspected for safety, comfort, cleanliness, telephone service, ventilation, and heating.

Off limit areas are all bedrooms, bathroom 2, kitchen area and garage. Licensee states that the living room will be used as a isolation area for sick children waiting to be picked up by a parent. Rooms that are off-limits need to be made inaccessible during operating hours. The licensee does understand that licensing staff may have access to off-limit areas during inspection visit, if necessary.
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NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Peter Bishop
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 02/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/12/2026
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MOORE FAMILY CHILD CARE
FACILITY NUMBER: 198016841
VISIT DATE: 02/12/2026
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Life-saving devices were inspected throughout the home. The smoke detector is located above the entrance of the kitchen. The carbon monoxide detector is located in the kitchen above the rear door of the home. All devices were tested and operable. The 2A 10 BC Fire extinguisher is located in the kitchen with a expiration date of 02/19/2026. Licensee was reminded that fire extinguisher needs to be serviced yearly. The home maintains telephone service via cell phone/LAN line.

Living room (Main care area) was observed to be clean and orderly. There are toys and other age-appropriate materials for the children. LPA observed the living room to have one table for children and there were colorful storage boxes, and individual cubbies for toys.



LPA observed the kitchen. Licensee stated that the baby gate is always present to make off limit’s kitchen inaccessible to children in care. Licensee stated that cleaning compounds in the bathroom in an inaccessible cabinet. Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, not only inaccessible to children.

LPA observed that the bathroom the children use is clean and free of floor hazards. There was toilet paper, hand-washing soap, and towels for the children. LPA did not observe any chemicals stored under the sink.

Per Licensee there are no firearms or weapons stored in the home. LPA did not observe any firearms or weapons in the home. Licensee states that there are no body of water present. LPA did not observe any bodies of water on the premises.

LPA observed the back yard for outdoor play. The outdoor play area was observed to be completely fenced. At the time of the inspection there were three slides and other age-appropriate toys. There was also a shaded area for the children as well. Licensee stated that they do not have any pets at the time of this inspection.

Staff records were reviewed for approved Pediatric First Aid and CPR certification. Valid CPR/First Aide was available at the time of inspection Licensee Moore is valid through 01/30/2028 Personnel Record, LIC 9052- Employee Rights, Proof of immunizations against measles, pertussis and influenza or influenza declination,
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NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Peter Bishop
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026
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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MOORE FAMILY CHILD CARE
FACILITY NUMBER: 198016841
VISIT DATE: 02/12/2026
NARRATIVE
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TB clearance or risk assessment available at the time of the visits. LIC 9108- Statement Acknowledging Requirement to Report Child Abuse is available and current Mandated Reporter Training Certificate was available with an expiration date of 04/01/2026. Children’s records were not reviewed.

Licensee Donice Moore 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.



Licensee Donice Moore 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 Donice Moore 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 Donice Moore 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/.
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NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Peter Bishop
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026
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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MOORE FAMILY CHILD CARE
FACILITY NUMBER: 198016841
VISIT DATE: 02/12/2026
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During the exit interview, Licensee Donice Moore confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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.

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

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Licensee Donice Moore

Appeal rights explained and given to Licensee Donice Moore.
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NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Peter Bishop
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026
LIC809 (FAS) - (06/04)
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