198017475-2-27-2026-54-CC-PBIP-DRPS4Z-20260227123333

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198017475
Report Date: 02/27/2026
Date Signed: 02/27/2026 12:33:48 PM

Document Has Been Signed on 02/27/2026 12:33 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:	CORNEJO FAMILY CHILD CARE		FACILITY NUMBER:	198017475
ADMINISTRATOR/ DIRECTOR:	CORNEJO, DILCIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 365-0420
CITY:	SOUTH GATE	STATE: CA	ZIP CODE:	90280
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 11	CENSUS: 2	DATE:	02/27/2026
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:30 AM
MET WITH:	Licensee Dilcia Cornejo		TIME VISIT/ INSPECTION COMPLETED:	12:45 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 Analyst (LPA) P Bishop arrived at the above facility for the purpose of an Unannounced Annual Visit on February 27, 2026 at 10:30 a.m. Upon arrival, LPA announced the purpose of the visit and was granted entry into the facility by Licensee Dilcia Cornejo 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 overnight care is being provided. Licensee Cornejo states that she does have 3 children that are enrolled 4:00 p.m – 10:30 PM. There were 2 children present during today's inspection. Licensee states that there is a total of 11 children enrolled. Licensee stated that there are 5 people that live in the home, which include herself. All of whom have a background clearance on file. 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, kitchen area rear outside play area. Outside play area was accessible. 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. 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. Page 1 of 4

NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Peter Bishop
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2026

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: CORNEJO FAMILY CHILD CARE	FACILITY NUMBER: 198017475
	VISIT DATE: 02/27/2026

NARRATIVE

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Life-saving devices were inspected throughout the home. The smoke detector is located in the living room as you enter the home and the carbon monoxide detector is located right next to the smoke detector. All devices were tested and operable. The 2A 10 BC Fire extinguisher is located in the Living Room and indicates fully charged and was serviced on 07/23/2025. 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 playpens, a diaper changing stations and two tables and chairs for activities. There were colorful storage boxes, and individual cubbies for toys.

LPA observed the kitchen. Licensee stated that the baby gate is broken. Licensee stated that cleaning supplies are made inaccessible to children in care with lock on cabinets. 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 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 Bishop observed the back yard for outdoor play. The outdoor play area was observed to be completely fenced. At the time of the inspection there was one slide and other age appropriate toys. There was also a shaded area for the children as well. Licensee stated that they do have one dog at the time of inspection. The dogs are kept away from children, and they are locked on the side of the house during operating hours.
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NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Peter Bishop
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2026

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: CORNEJO FAMILY CHILD CARE	FACILITY NUMBER: 198017475
	VISIT DATE: 02/27/2026

NARRATIVE

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Staff records were reviewed for approved Pediatric First Aid and CPR certification. Valid CPR/First Aide was available at the time of inspection Licensee Dilcia Cornejo is valid through 10/18/2027 and Assistant through 10/26/2026. LIC-501: Personnel Record, LIC 9052- Employee Rights, Proof of immunizations against measles, pertussis and influenza or influenza declination, 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 and is in compliance for both Licensee and Assistant with expiration dates of 11/14/2026 and 8/15/2026. LPA advised Licensee that it is due for renewal every 2 years.

Children’s records were reviewed LIC 700 Identification and Emergency Information, LIC 627 Consent for Emergency Medical Treatment, LIC 995A Notification of Parents rights and Immunizations were all current and up to date. LIC 9227 was on file and the Infant Sleep Chart had been completed for both infants in care.
Licensee Dilcia Cornejo 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 Dilcia Cornejo 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 Dilcia Cornejo 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 Dilcia Cornejo 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.

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NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Peter Bishop
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2026

LIC809 (FAS) - (06/04)

Page: 5 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: CORNEJO FAMILY CHILD CARE	FACILITY NUMBER: 198017475
	VISIT DATE: 02/27/2026

NARRATIVE

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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/.

During the exit interview, Licensee Dilcia Cornejo 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.

There will be no deficiencies cited today.

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

Exit interview conducted and report was reviewed with Licensee Dilcia Cornejo

Appeal rights explained and given to Licensee Dilcia Cornejo .

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NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Peter Bishop
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2026

LIC809 (FAS) - (06/04)

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