198018986-6-12-2026-33-CC-MRUZ-DUYT33-20260612142139

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198018986
Report Date: 06/12/2026
Date Signed: 06/12/2026 02:22:14 PM

Document Has Been Signed on 06/12/2026 02:22 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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	RIVEROS FAMILY CHILD CARE		FACILITY NUMBER:	198018986
ADMINISTRATOR/ DIRECTOR:	RIVEROS, NAYELI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 401-5639
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90022
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 19	CENSUS: 13	DATE:	06/12/2026
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:45 AM
MET WITH:	Licensee, Nayeli Riveros		TIME VISIT/ INSPECTION COMPLETED:	02:45 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	On 6/12/2026 Licensing Program Analyst (LPA) Monica Ruiz conducted an unannounced annual random inspection of the facility noted above. LPA was greeted by Licensee, LPA presented identification, disclosed the purpose of the inspection to Licensee and provided LIC126- Entrance Checklist. Licensee states her hours of operation are 5am – 6pm, Monday – Friday. This facility is licensed for a capacity of 14 children. Licensee states that there are currently 19 children enrolled, there were 13 children present and 2 children were picked up during this visit. Also, present were 3 of the Licensees children that do not count towards ratio. Licensee states that 2 of her children work with her as assistants in her FCCH. Adults in the home were discussed. LPA Ruiz informed Licensee that any changes to the facility’s hours of operation, people providing care to day care children, or changes to the home, must be reported to Licensing immediately. LPA inspected the facility for safety, comfort, cleanliness, ventilation and working cell phone. The facility has central air and heat for ventilation. LPA observed furniture, manipulatives, books, soft plush toys and other age-appropriate materials to be well maintained and free of loose, sharp, and pointed parts. LPA observed cleaning compounds items, stored underneath the kitchen sink and bathroom cabinet, and observed a child safe lock in place, making it inaccessible for children to open. page 1

NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Monica Ruiz
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2026

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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: RIVEROS FAMILY CHILD CARE	FACILITY NUMBER: 198018986
	VISIT DATE: 06/12/2026

NARRATIVE

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LPA observed the knives and sharp objects to be stored on the kitchen counter. There is a barrier gate firmly in place making the kitchen inaccessible to children in care. Licensee was reminded that reassessment of hazards is required depending on the ages of children in care.

The licensee states that she works with Options food program and the facility provides breakfast, lunch, morning and afternoon snack. LPA informed Licensee that if any food is brought from the children's homes, the container shall be labeled with the child's name and properly stored or refrigerated. For water drinking, licensee stated she provides water. Licensee also works with Plaza Community Services, resource and referral agency.

LPA entered the bathroom and observed a working toilet, sink with hand soap and the bottom sink cabinet was closed with an operable child safe lock. LPA reminded licensee and personal items (ex; shampoo, toothpaste, mouthwash, or items that fall into that category) must be made inaccessible to children.

LPA observed 2 small dogs that are kept in the far back yard behind a gate making them inaccessible to the children in care. LPAs did not observe any poisons, firearms, weapons, or bodies of water and the licensee stated she does not have any of the above. The licensee was informed that if any poisons (ex; drain cleaner, rat poison or items that fall into that category), firearms and weapons are purchased, it is required to be locked with a key or combination lock and firearm and ammunition must be stored separately.

At time of inspection, LPA observed the required 2A10BC fire extinguisher located in the kitchen and the valve on the green area indicating fully charged and purchased on 10/2024. LPA observed a carbon monoxide detector and smoke alarm located in the kitchen. LPA could not test the smoke detector and carbon monoxide detector due to children napping.

LPA observed the first aid kit in the living room to be complete with band aids, gauzes, adhesive bandages, antiseptic wipes and scissors. For ill isolation, licensee states she uses Bedroom 1. LPA observed the last emergency drill conducted on 5/11/26.
LPA observed the front yard and front half of the driveway to be used for outdoor play. There is shade in the front yard.
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NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Monica Ruiz
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/12/2026 02:22 PM - It Cannot Be Edited

Created By: Monica Ruiz On 06/12/2026 at 01:56 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: RIVEROS FAMILY CHILD CARE	FACILITY NUMBER: 198018986
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/12/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(2)(d)

This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above in 2 out of 2 infant children files did have safe sleep logs, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/13/2026
	Plan of Correction
1 2 3 4	Licensee staes she will document safe sleep for the infant's (ages 0-24 months) in care for 3 weeks and will send copies of the sleep logs to LPA Ruiz/Licensing by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Katrina Chicote
NAME OF LICENSING PROGRAM MANAGER:

	Monica Ruiz
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2026

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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: RIVEROS FAMILY CHILD CARE	FACILITY NUMBER: 198018986
	VISIT DATE: 06/12/2026

NARRATIVE

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LPA observed Licensee’s Pediatric First Aid/ CPR certification and expires 6/2027 and licensee has proof of immunization against Pertussis, MMR, and Influenza. Licensee completed the Child Abuse Mandated Reporter (AB 1207) training on 6/10/2025. Licensee was advised that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com

- CPR Card valid until: 6/2027
- Fire Extinguisher was serviced on: 4/25/2026
- Mandated Reporter AB1207 Completed: 6/10/2025

LPA Ruiz observed the following required postings in the entry way of the facility; License, LIC 9148 Earthquake Preparedness Checklist, LIC 610A Emergency Disaster Plan, Pub 394 Notification of Parents Rights, and LIC 999 Facility sketch.

LPA also reviewed children’s roster and children’s files. LPA observed the 2 out of 12 children’s files to be missing proof of immunization.
LPA observed that 2 children’s files are missing the Individual Infant Sleep Plan (LIC 9227) and Safe Sleep Logs. Licensee states that she documents the safe sleep but does has not been keeping the safe sleep logs. Licensee will receive a Type B deficiency, as this poses a potential hazard to infants in care.

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.

Family Child Care Homes 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.

NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Monica Ruiz
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2026

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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: RIVEROS FAMILY CHILD CARE	FACILITY NUMBER: 198018986
	VISIT DATE: 06/12/2026

NARRATIVE

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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-andresources/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. Licensee states that none of the children enrolled take medication.
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.
LPA Ruiz discussed assistant requirements, capacity and ratio with Licensee.

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

Based on this information, the following deficiencies on the attached LIC 809D are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

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

Exit interview was conducted and report was reviewed with the Licensee Nayeli Riveros. Appeal Rights were provided and discussed

NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Monica Ruiz
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2026

LIC809 (FAS) - (06/04)

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