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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018091
Report Date: 08/18/2025
Date Signed: 08/27/2025 10:59:44 AM

Document Has Been Signed on 08/27/2025 10:59 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:CALLE-MEDINA FAMILY CHILD CAREFACILITY NUMBER:
198018091
ADMINISTRATOR/
DIRECTOR:		CALLE, J. & MEDINA, IFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 484-9092
CITY:SOUTH GATESTATE: CAZIP CODE:
90280
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
08/18/2025
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:57 AM
MET WITH:Jenny CalleTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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Amended report as of 8/26/25. Pg 2. Lines 22-23. On August 18, 2025, at 8:57 a.m., Licensing Program Analyst (LPA) Peter Bishop arrived at the above facility for the purpose of conducting an unannounced/Annual Visit. LPA Bishop announced the purpose of the visit and was granted entry into the facility by Licensee Jenny Calle. Licensee gave LPA a tour of the facility and a census was taken. There are 10 children enrolled, and 9 children present at the time of Visit. LPA observed an ADU in the process of being built. Licensee informed and showed LPA the alternate entrance for pick up and drop off of children. Licensee further indicated that she meets the parents at the front and walks the children to the home safely. Four large pallets of wood were observed in the front yard and Licensee indicated they had to temporarily stop building due to lack of workers. The hours of operation are Monday- Friday from 6:00am-6:00pm. All adults in the home were discussed and background and fingerprinted cleared. License, earthquake disaster checklist (LIC9148), disaster plan, and PUB 394 posted. The Licensee does have current LIC 9040 (facility roster) A disaster drill log with last drill conducted on 8/1/2025.

This is a one-story home which consists of 3 bedrooms, 2 bathroom, kitchen, dining room, living room, and backyard (fenced). The off-limit areas include All 3 bedrooms and second bathroom. The kitchen is observed to have a baby gate that prevents children from entering the kitchen. The kitchen is total off limits and the children do not have access to the kitchen. LPA observed all of the drawers and cabinets to have age-appropriate safety locks in place. Per licensee the back yard is used as the outside play area.

The living room area is an approved area where the children are cared for. Licensee stated that she does allow children to sit and wait for their parents if the become sick. LPA Bishop observed the area to have area
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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Peter Bishop
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/18/2025
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: CALLE-MEDINA FAMILY CHILD CARE
FACILITY NUMBER: 198018091
VISIT DATE: 08/18/2025
NARRATIVE
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rug, TV, soft furnishings for relaxation, library area, color cards that allow children to identify colors and shapes. There is playpen in this main care area. LPA observed all furnishings, equipment, and material to be in good condition.

The second main care area is next to the living room. This room consist of two tables 10 chairs one playpen. There is an area rug, table and chairs and other age appropriate toys.

The off-limit rooms were observed to be locked and made inaccessible at the time of the visit.

LPA Bishop observed the kitchen area. The cabinets and drawers have safety latches making hazardous materials inaccessible to children in care. The knives are stored in a cabinet out of reach of children.
LPA Bishop observed the bathroom with an operable toilet and sink. The cabinets and drawers have safety latches making it inaccessible to children in care. LPA observed that there were not any hazards in the bathroom. Soap and paper towels were observed in the bathroom as well.

LPA Bishop observed the outdoor area to have soft area pads throughout the backyard. There was a shaded area observed by LPA Bishop. There are age-appropriate toys, picnic tables, balls, bikes and an age-appropriate slide. LPA observed all furnishings, equipment, and material to be in good condition. LPA observed outdoor area to be in good condition, free of sharp, loose, or pointed parts. The backyard is fenced as well.

LPA observed a fire extinguisher with a valid service tag.

LPA observed a dual smoke detector and carbon monoxide detector to be operable. They are located in the hallway.
The Licensee stated that they do provide meals for children.

The Licensee stated they use a cell phone, and landline.

The Licensee stated they do not have any children that they administer medication to at this time.

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Peter Bishop
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2025
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: CALLE-MEDINA FAMILY CHILD CARE
FACILITY NUMBER: 198018091
VISIT DATE: 08/18/2025
NARRATIVE
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The Licensee stated that when children are sick, they are placed by in the living room area by the door.

The Licensee stated there are no firearms in the home.

The Licensee stated that there are no smokers in the home.

The Licensee stated that they do not provide transportation for children.
The Licensee stated that they do have a first aid kit.

The Licensee stated that they do provide nap time. Cots are stored in an off limits area.

The Licensee stated that there are no large bodies of water on the premises. LPA did not observe in bodies of water.

The Licensee does not have any pets. LPA did not observe any pets.
Staff Files:
Staff # 1
All necessary documents were present and in file.
CPR & First Aid expiration date 10/20/2025
Mandated Reporter expiration date of 7/8/2027

Staff # 2
All necessary documents were present and in file.
CPR & First Aid expiration date 10/20/2025
Mandated Reporter expiration date of 7/8/2027

Staff # 3
All necessary documents were present and in file.
CPR & First Aid expiration date 1/12/2026
Mandated Reporter expiration date of 7/8/2027

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Peter Bishop
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2025
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: CALLE-MEDINA FAMILY CHILD CARE
FACILITY NUMBER: 198018091
VISIT DATE: 08/18/2025
NARRATIVE
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Children’s Files
Child #1
All required licensing forms and immunization record in file.
Safe Sleep Log was observed.
Child #2
All required licensing forms and immunization record in file.
Safe Sleep Log was observed.
Child #3
All required licensing forms and immunization record in file.
Child #4
All required licensing forms and immunization record in file.
Child #5
All required licensing forms and immunization record in file.
To improve the quality and value of the new Visit process, a survey may be sent to the email address provided. Please complete the survey and share your Visit experience. If you have any questions regarding the process or CARE tools, please send email inquiries to Visitprocess@dss.ca.gov. For additional information regarding the Visit and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/Visit-process
Criminal Record Clearance - Family Child Care Homes Licensee Jenny Calle 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.
Safe Sleep
LPA discussed the safe sleep regulations with Licensee Jenny Calle and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informedLicensee Jenny Calle of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Peter Bishop
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2025
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: CALLE-MEDINA FAMILY CHILD CARE
FACILITY NUMBER: 198018091
VISIT DATE: 08/18/2025
NARRATIVE
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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)
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-carecenters/.

MyChildCarePlan.org – Centers and Family Child Care Homes Licensee Jenny Calle 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.
Megan’s Law - Family Child Care Homes During the exit interview, the Licensee Jenny Calle confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
Based on the LPA P Bishops observations, record review, and interviews, there will not be any deficiencies cited today in accordance with California Title 22 Regulations.

A notice of site visit was given and must remain posted for 30 days.
Appeal rights explained and given to Licensee Jenny Calle.
Exit interview conducted and report was reviewed with the Licensee Jenny Calle


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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Peter Bishop
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2025
LIC809 (FAS) - (06/04)
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