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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020026
Report Date: 04/30/2026
Date Signed: 04/30/2026 11:11:52 AM

Document Has Been Signed on 04/30/2026 11:11 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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:PEREYRA FAMILY CHILD CAREFACILITY NUMBER:
198020026
ADMINISTRATOR/
DIRECTOR:		GABRIELA PEREYRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 738-1634
CITY:MONTEBELLOSTATE: CAZIP CODE:
90640
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
04/30/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Gabriela PereyraTIME VISIT/
INSPECTION COMPLETED:
11:27 AM
NARRATIVE
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Licensing Program Analyst (LPA) Veronica Martinez Garza conducted an unannounced Case Management Incident inspection at the above facility on 04/30/26 at 08:45 a.m. The purpose of this inspection is to follow up on an incident that was reported to the Department on 04/15/26. At 08:49 a.m., LPA met with the licensee Gabrieal Pereyra who guided LPA on a tour of the facility and census was taken.

During this inspection, LPA interviewed Staff 1 (S1 thru 2). LPA also obtained additional documentation pertaining to Child 1 (C1).

On 04/08/26 at approx. 10:00 a.m. child #1 (C1) was playing outside in the backyard and fell. S1 assessed the child and in that moment, there was no bruising observed. The unusual incident report indicates that C1 was running and accidentally fell which caused the child to develop a minor bruise on the lower left knee.

Interviews conducted with staff revealed that on 04/08/26, C1 was running while outdoors in the backyard and suddenly fell; however, there was no bruising, marks, scrapes, or blood observed. Staff revealed that the child did not cry or complain about pain after the fall and continued to engage in other activities. According to staff, C1 had been observed with shoes that seemed to fit too big because the child’s feet would come out of the shoe. Per S1, C1 began attending the facility on 04/06 and observed that the child’s shoes were too big which S1 notified the child’s parent via text message. Staff revealed that though the parent of C1 was notified of the shoes being too big the child returned the following day with the same shoes though the parent had mentioned they would provide the child with other shoes that would fit better. LPA received a screenshot of the text messages between S1 and parent of C1 regarding the fit of the child's shoes. LPA observed that the parent of C1 informed S1 that they would get other shoes that fit better.

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NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Veronica Martinez-Garza
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/30/2026
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: PEREYRA FAMILY CHILD CARE
FACILITY NUMBER: 198020026
VISIT DATE: 04/30/2026
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On 04/08, S1 stated that during pick up they notified the child’s parent/authorized representative of the fall and recalled that the child left with no marks, bruising, scrapes, or blood. S1 stated that the child’s authorized representative called later that day and stated that the child had a bruise on their lower knee and that the child kept complaining of pain. According to S1, the child’s authorized representative wanted to know how the child fell since there were no scrapes. Per S1, they explained how the child fell and also informed the authorized representative that the child’s parent was notified that the shoes were too big; however, the authorized representative replied that they were not made aware. Per staff, C1 fell several times at the facility due to the shoes fitting to big. Staff also stated that the child is no longer attending the facility and the last day was on 04/09.

During today’s inspection, LPA toured the backyard and observed that the entire yard is cement. The floor is in good condition and there were no hazards observed. LPA advised the licensee to place a cushioning material under the small sliding play structure.

LPA also observed that the sliding door in the children’s bedroom has a screen that is falling apart and the middle of the laminate floor separated. LPA provided a technical violation.

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.

The Notice of Site Visit (LIC 9213) must remain posted for 30 days during the hours of operation after each site visit by a licensing representative, a civil penalty of $100 can be assessed.

An exit interview was conducted, and a copy of this report was provided to the licensee Gabriela Pereyra.

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NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Veronica Martinez-Garza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2026
LIC809 (FAS) - (06/04)
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