198021118-8-27-2026-33-CC-MRUZ-DXCUXH-20260827155822

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198021118
Report Date: 08/27/2026
Date Signed: 08/27/2026 03:58:30 PM

Document Has Been Signed on 08/27/2026 03:58 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:	MADRIGAL FAMILY CHILD CARE		FACILITY NUMBER:	198021118
ADMINISTRATOR/ DIRECTOR:	MADRIGAL, REBECA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(213) 434-1458
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90031
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS:	DATE:	08/27/2026
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:00 PM
MET WITH:			TIME VISIT/ INSPECTION COMPLETED:	04:15 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 8/27/2026 at 2:00 pm Licensing Program Analyst (LPA) Monica Ruiz conducted a case management inspection due to a self reported incident that occurred at the facility on 8/20/2026. LPA Ruiz met with Licensee Rebeca Madrigal , and explained reason for visit. LPA observed 8 children in care with Licensee and assistant (S1). LPA Ruiz toured the facility indoors and outdoors, and interviewed Licensee and S1. LPA Ruiz and Licensee discussed the self reported incident that occurred on 8/20/2026 where an infant in care fell back from a sitting position and lost consciousness for 1-3 seconds. Licensee states that on 8/20 at approximately 9:30 am, Licensee, assistant (S1) and 7 children in care were playing in the outdoor play area. Licensee states they were in the gated infant area observing 3 infants play. S1 was supervising the 4 older children in the outdoor toddler play area. Licensee states that child 1 (C1) was sitting and watching the older children play when C1 fell backward from a sitting position onto the carpeted ground. Licensee states that C1 let out a big cry, so they picked up C1 to comfort them when they observed C1 was not breathing. page 1 of 2

Katrina Chicote
Monica Ruiz
	DATE: 08/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2026

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

FACILITY NAME: MADRIGAL FAMILY CHILD CARE	FACILITY NUMBER: 198021118
	VISIT DATE: 08/27/2026

NARRATIVE

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Licensee states they asked S1 to call 911 and as S1 was dialing 911, C1 opened their eyes and began to breathe normally. Emergency Medical Services (EMS) arrived shortly after the 911 call was placed and evaluated C1. Licensee and S1 state that first responders stated that C1 was breathing normally, vitals were good, but suggested C1 be taken to the hospital for evaluation.

Licensee states C1’s mother arrived and rode to hospital in the ambulance with C1. Licensee states that C1 was discharged approximately 1-2 hours later and was cleared to return to day care. Licensee states that C1’s mother told them that C1 had no signs of injury and that doctors told C1’s mother that C1 had a “breath holding spell”. C1’s mother provided a note from C1's primary care physician that C1 was cleared to return to day care on or after 8/24/2026.

LPA toured the outdoor play area and observed the infant play area to have a barrier gate surrounding the carpeted infant area. Licensee states they placed an additional foam mat under the carpet, to absorb the impact from any potential falls. LPA observed outdoor infant area to have 2 carpets and a foam mat to absorb any potential falls. LPA did not observe any potential hazards in the play area on this day.

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

NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Monica Ruiz
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2026

LIC809 (FAS) - (06/04)

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