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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016984
Report Date: 08/21/2025
Date Signed: 08/22/2025 05:41:25 AM

Document Has Been Signed on 08/22/2025 05:41 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:ENGBERG FAMILY CHILD CAREFACILITY NUMBER:
198016984
ADMINISTRATOR/
DIRECTOR:		ENGBERG, TONIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 233-9872
CITY:LAKEWOODSTATE: CAZIP CODE:
90712
CAPACITY: 14TOTAL ENROLLED CHILDREN: 15CENSUS: 11DATE:
08/21/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Licensee, Toni EngbergTIME VISIT/
INSPECTION COMPLETED:
05:29 PM
NARRATIVE
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On 08/21/2025, Licensing Program Analyst (LPA) J. Culbert conducted an unannounced case management inspection at the facility noted above. LPA met with licensee, Toni Engberg and informed them of the purpose for today’s inspection. The purpose of the visit is to follow up on an incident the licensee reported on 05/22/2025. On that day licensee reported that they put child 1 down for a nap. Child 1 climbed out of the crib and broke a glass item. The child was scratched, and red marks were found on them.

On 05/21/2025 Child 1 refused to take a nap. Per licensee, they attempted to lay child 1 down for a nap multiple times, but they refused to go to sleep. When they laid child 1 down and walked away, they immediately heard the glass break. Per licensee, when they went back into the room, they found Child 1 sitting on a pile of glass.

LPA took photos and interviewed staff and licensee. LPA took photos of the bedroom where the incident occurred and conducted interviews. During interviews, licensee stated that they and staff were aware that child 1 knew how to climb out of the crib. Per licensee, “[Child 1] had done it in the past. We knew [they] could do it”. This is a potential safety and personal rights risk to persons in care. Per licensee, they tried placing child 1 on a cot, but they would run around the house. LPA reminded licensee that cribs and play yards are for infants who are unable to climb out of the crib or play yard.

During interview, licensee stated that the crib was placed less than a foot from the dresser. Per licensee, the glass jar was located on the dresser and the crib was situated in the room between the bed and the dresser.

NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Jonnisha Culbert
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/21/2025
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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Document Has Been Signed on 08/22/2025 05:41 AM - It Cannot Be Edited


Created By: Jonnisha Culbert On 08/21/2025 at 04:43 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: ENGBERG FAMILY CHILD CARE
FACILITY NUMBER: 198016984

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/22/2025
Section Cited
CCR
102423(a)(2)

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Personal Rights 102423 (a)Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee... (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment

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Per licensee, they will provided LPA J. Culbert with a declaration stating that they will remove all accessible hazards from on limits areas in the home and email declaration to LPA J. Culbert by plan of correction date.
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This requirement was not met as evidence by:
Based on interview, the licensee left child 1 alone in bedroom with accessible glass. This is an immediate safety and 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.
Warren Birks
NAME OF LICENSING PROGRAM MANAGER:
Jonnisha Culbert
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/21/2025


LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 08/22/2025 05:41 AM - It Cannot Be Edited


Created By: Jonnisha Culbert On 08/21/2025 at 05:14 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: ENGBERG FAMILY CHILD CARE
FACILITY NUMBER: 198016984

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/28/2025
Section Cited
CCR
102425(a)

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102425 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 requirment was not met as evidence by:
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Per licensee, they will provide LPA a declaration stating that if they have knowledge of a child climbing out of the crib, they will no longer place that child in a crib. Per licensee, they will email signed declaration to LPA J. Culbert by plan of correction date.
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Based on interview,the licensee did not comply with the section cited above. Per licensee, child 1 was placed in the crib. However, licensee and staff were aware that child 1 can climb out of the crib. This is a potential safety risk to persons in care.
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Type B
08/28/2025
Section Cited
CCR102416.2(a)(3)(C)

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Reporting Requirements 102416.2 (a)(3)(c) The licensee shall report the following information the Department by telephone or fax within the Department's next business ...(C)Any unusual incident..
This requirement was not met as evidence by:
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Per licensee, they will complete an unusual incident report form and email it to LPA J. Culbert by plan of correction date.
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Based on interview, the licensee did not comply with the section cited above. During interview, licensee indicated that law enforcement informed her that she had a warrant. Per license, they did not know they had to report it. This is a potential safety and 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.
Warren Birks
NAME OF LICENSING PROGRAM MANAGER:
Jonnisha Culbert
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/21/2025


LIC809 (FAS) - (06/04)
Page: 4 of 5
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: ENGBERG FAMILY CHILD CARE
FACILITY NUMBER: 198016984
VISIT DATE: 08/21/2025
NARRATIVE
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LPA observed that the dresser was not tall enough to make the items on top of it (glass jar) inaccessible to children in care. This is an immediate safety and personal rights risk to persons in care. LPA reminded licensee that children in care are to receive safe, healthful, and comfortable accommodations, furnishings, and equipment.

During case management inspection on 08/12/2025 LPA Jonnisha Culbert and Licensing Program Manager (LPM) Warren Birks were made aware by the licensee that they received direction from a law enforcing to respond to a warrant via text message. LPA informed licensee that per title 22 under reporting requirements, they are required to report such incidents to The Department within 24 hours of occurrence. Per licensee, they did not think to report this incident to The Department. This is a potential safety and personal rights risk to the persons in care.

Note: Licensee was informed by LPA that this incident may require additional follow-up at a later date.

During today’s visit, LPA issued one type A citation and three type B citations were issued during today’s visit.

LPA Jonnisha Culbert informed licensee, Toni Engberg that this report dated 08/21/2025 documents one Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Jonnisha Culbert informed the licensee, Toni Engberg to provide a copy of this licensing report dated 08/21/2025 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt Licensing Report (LIC 9224), or other written statement, must be placed in the child’s file for verification.

A 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.

Appeal rights were provided, and an exit interview was conducted with licensee, Toni Engberg

NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Jonnisha Culbert
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
LIC809 (FAS) - (06/04)
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