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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020949
Report Date: 05/28/2026
Date Signed: 05/28/2026 02:13:04 PM

Document Has Been Signed on 05/28/2026 02:13 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:PEREYRA FAMILY CHILD CAREFACILITY NUMBER:
198020949
ADMINISTRATOR/
DIRECTOR:		PEREYRA, VERAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 494-4034
CITY:LOS ANGELESSTATE: CAZIP CODE:
90022
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
05/28/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:LicenseeTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On 5/28/2026 Licensing Program Analysts (LPA) Monica Ruiz conducted an unannounced annual random inspection of the facility noted above. LPA was greeted by Licensee, Vera Pereyra. LPA presented identification, disclosed the purpose of the inspection to Licensee and provided LIC126- Entrance Checklist.
Licensee states that there are currently five (5) children enrolled, there were three (3) children present during this visit. Licensee states that 2 children are absent.

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.

The children's roster was available for review and is current. Adults in the home were discussed.
Licensee was reminded that if no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home. Per Licensee, the facility’s hours of operation are Monday – Friday, 6am – 5pm.

Emergency Disaster Plan, License, and Parents’ Rights were observed to be posted on the wall by the television, in the living room. Disaster drill log was available during today’s inspection and last drill documented was on 5/8/2026.

This is a one-story home which consists of 2 bedrooms, 1 bathroom, living room, dining room, kitchen, laundry area (between 1 bedroom and bathroom), front yard (fenced), and back yard (fenced).
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NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Monica Ruiz
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/28/2026
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: 198020949
VISIT DATE: 05/28/2026
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Areas accessible to children include living room, dining room, kitchen, bedroom #1 (next to the bathroom), 1 bathroom, and front yard. Per licensee, areas off-limits to children and parents include 1 bedroom and back yard. According to the licensee, there are no pets on the premises, and none were observed on this day.
LPA reminded Licensee that construction or any changes to the areas used by children must be reported to licensing. All areas identified on the facility sketch were inspected to ensure that they are clean and orderly with ventilation and heating for the safety and comfort of the children. There is a working telephone maintained in the home.
The living room and bedroom #1 are the main day care areas. LPA observed age-appropriate toys such as blocks, books, art supplies, dramatic play materials, and sensory toys all free of loose and sharp parts.

Licensee states that children nap in the living room on cots. LPA observed cots to be stored in bedroom #1, in the closet. LPA observed one play yard for infant in care to be stored in the living room, not in use. LPA observed that Licensee Pereyra added 2 hard foam cushions under the play pen mat. Licensee states that she placed the foam there so the infant would not be so low. LPA Ruiz informed Licensee that modifications to crib(s) or play yard(s) are not allowed. This poses a potential risk to the children in care at the time of this visit. Licensee will receive a Type B deficiency. LPA observed Licensee removed the foam cushions from the premises. Children present during this visit do not use the play pen. Licensee states that children present use cots for napping. Safe Sleep requirements were discussed with Licensee.

Licensee states that there are no poisons stored in the home. Licensee does understand that poison must be locked. The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Personal Rights of children were observed by LPA at time of inspection.

Licensee states that children play outside in the front yard daily, when the weather permits. LPA Ruiz toured the front yard and observed a toddler sized play structure, a dramatic play house, tricycles and push cars, all in good condition, free of loose, sharp, or pointed parts.



LPA observed an air conditioning unit/swamp cooler to be mounted in the living room window. LPA observed the Ac unit to be partially supported by a wood plank, accessible to children in care. This poses a potential risk to children in care. Licensee will receive a Type B deficiency. LPA advised Licensee to make the AC unit inaccessible to children in care, photo taken.
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NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Monica Ruiz
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2026
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: PEREYRA FAMILY CHILD CARE
FACILITY NUMBER: 198020949
VISIT DATE: 05/28/2026
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Trees, grass, shrubs, and plants are maintained. LPA observed that the front yard is fenced along the perimeter.
LPA reminded licensee that 100% supervision is always required when children are playing outside.
Licensee provides food for children in care. Licensee provides breakfast, morning snack, lunch, afternoon snacks and dinner. Licensee states that the meals provided depend on the hours a child is in care.
Licensee works with Plaza Community Services resource and referral agency.

Licensee states that a sick child can rest on the coach in the living room, until their parents can pick them up and that they use physical distancing to keep sick children isolated.

Per Licensee, there are no weapons or firearms in the home, and none were observed during this inspection. Licensee states there are no pools or bodies of water on the premises, and none were observed on this day.

The valve on the required 2A 10BC fire extinguisher indicates fully charged and was purchased in 3/12/2026. Fire extinguishers are to be serviced or replaced annually. Smoke detector and carbon monoxide detectors were both tested at 12:30pm and are functioning at this time.

LPA observed First Aid Kit to be mounted on the wall in the living room and was reviewed for necessary supplies.

The following were discussed:
Rooms that are off-limits need to be made inaccessible during operating hours. NO smoking, NO infant walkers, NO Johnny jumpers, NO saucer chairs, NO incline sleepers and any other item that falls into that category are permitted in the facility. Effective January 1, 2010, licensees of family child care homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present.
Licensee’s CPR certificate expires on 10/3/2027.

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NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Monica Ruiz
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2026
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: PEREYRA FAMILY CHILD CARE
FACILITY NUMBER: 198020949
VISIT DATE: 05/28/2026
NARRATIVE
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The Licensee has current Pediatric First Aid and CPR. Proof of immunization against pertussis, and measles was readily available during today’s inspection. The Licensee has also taken the Mandated Reporter Training.
- CPR Card valid until: 10/3/2027
- Fire Extinguisher was purchased on: 3/2026
- Mandated Reporter AB1207 Completed: 3/12/2026
- Children’s records and required licensing forms were discussed as well as
mandated child abuse reporting and criminal record clearance requirement.

AB 1207: Beginning on January 1, 2018, this law requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: http://www.mandatedreporterca.com/
Licensee has a valid mandated reporter certificate on file that expires on 7/8/2027.

Senate Bill 792: this bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles. LPA observed a current influenza waiver during this visit.

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.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.


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NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Monica Ruiz
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2026
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: PEREYRA FAMILY CHILD CARE
FACILITY NUMBER: 198020949
VISIT DATE: 05/28/2026
NARRATIVE
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LPA discussed the safe sleep regulations with licensee and facility representative 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 and facility representative 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.
Licensee states that she does not provide overnight care. Incidental Medical Services (IMS) policy was discussed. Licensee states she does not offer IMS.
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.

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.

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

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Licensee, Vera Pereyra

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NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Monica Ruiz
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/28/2026 02:13 PM - It Cannot Be Edited


Created By: Monica Ruiz On 05/28/2026 at 01:36 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: PEREYRA FAMILY CHILD CARE
FACILITY NUMBER: 198020949

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/28/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in 1 out of 2 window air conditioning units to be accessible to children in care, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/26/2026
Plan of Correction
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Licensee states she will obtain a child safety gate or a safe barrier item, and place it infront of the AC unit, to ensure that children in care will not be able to reach the air conditioning unit that is mounted in the living room window.
Type B
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in 1 out of 1 play yard had foam cushions under mat, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/26/2026
Plan of Correction
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Licensee states she will watch go to website, link provided, https://safetosleep.nichd.nih.gov, and watch video provided in her preferred language. Licensee states she will watch a video on Safe Sleep, review guidlines and requirements, and submit a statement of her understanding of the Safe Sleep regulations by POC date.
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: 05/28/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/28/2026


LIC809 (FAS) - (06/04)
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