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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021633
Report Date: 08/08/2025
Date Signed: 08/08/2025 12:56:29 PM

Document Has Been Signed on 08/08/2025 12:56 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:VARGAS FAMILY CHILD CAREFACILITY NUMBER:
198021633
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
08/08/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Licensee, Sandra VargasTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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.Licensing Program Analyst (LPA) Monica Ruiz arrived at the facility noted above to conduct an announced Case Management Inspection initiated by Licensee for the purpose of increasing their capacity from small (6-8 children) to large (12-14 children) Family Child Care Home. Fire clearance approved for a capacity of 14 children by Inspector, Laurence Kim on 7/7/2025.
LPA Ruiz was greeted by Licensee Sandra Vargas a provided a tour of the family child care home. There were 4 children in care and two assistants present at the time of this visit. Licensee states that there are 8 children enrolled at this time. Adults in the home were discussed.

Licensee is licensed for a small family child home, facility number 198020828. The hours of operation are Monday-Friday 12AM until 11PM. Ages to be served will be ages 0 to 12 years old. The following was observed.

All areas identified on the facility sketch were inspected. This is a one story home which consists of 3 bedrooms, 2 bathrooms, living room, kitchen, and back yard with a detached garage. Per applicant parents of children in care will enter the facility through the main front entrance located on 2nd St.

Per licensee, there are no pets or bodies of water and none were observed. Applicant states she does not own any fire arms. There is central heating and air conditioning. There were no wall heaters or fire places observed.

Areas that are accessible to children are as follows: Living room, 1 bathroom, and a part of the backyard.

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NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Monica Ruiz
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/08/2025
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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: VARGAS FAMILY CHILD CARE
FACILITY NUMBER: 198021633
VISIT DATE: 08/08/2025
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Areas off limits include: 3 bedrooms, 1 bathroom, kitchen, front yard, and a portion of the backyard where the detached garage is located.

LPA observed that the backyard is separated into two parts using a wooden gate. There are tricycles and toys, for various ages, in good condition, available to play with. The part of the garage containing the detached garage is off limits. The detached garage is used for storage per applicant. LPA Ruiz inspected garage and verified that garage is only used for storage.

LPA Ruiz advised Licensee to place an additional lock or latch on the wooden gate that separates the backyard from the detached garage/ADU area, to ensure that children will not access the ADU/detached garage area.

LPA Ruiz informed Licensee that the adult residing in ADU/detached garage area must be fingerprint cleared. License states they will ask resident for a Live Scan. Licensing forms LIC 9163, LIC 508, and LIC 9182 were provided to Licensee.

Fire extinguisher was observed near the front entrance of the home with a service date of 08/30/2024. Licensee was reminded that fire extinguishers must be serviced or replaced annually. First Aid kit is located in the kitchen. Smoke and carbon monoxide detectors were observed in the living room and were in operating condition.

The applicant owns this home. A copy of the deed was provided by the applicant to LPA Lee prior to the inspection and is on file at program office.

All areas of the family child care home, including the off limits areas, were inspected by LPA Ruiz during this inspection. Age appropriate toys and furniture were observed in the living area which will be used by the children in care.

The cabinets and drawers in the bathroom used by children were observed to be latched. LPA observed cleaning products and potentially hazardous materials to be stored in the off- limits kitchen.

Playpens for infants were observed in the living room. Napping equipment such as mats were observed in the closet next to the restroom used by children. Licensee states blankets and bedding are provided by licensee, washed and sanitized by facility at least twice a week.

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

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

DATE: 08/08/2025
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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: VARGAS FAMILY CHILD CARE
FACILITY NUMBER: 198021633
VISIT DATE: 08/08/2025
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The following was discussed with the applicant:

· Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.


· In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification clearance, and a valid criminal record clearance associated with the facility license. Safe sleep requirements were discussed. LPA Ruiz provided PIN 20-24-CCP-SP.
LPA Ruiz observed required postings (LIC 6101A Emergency Disaster Plan,
PUB394 Notification of Parents Rights Poster, Facility License, Emergency Disaster Plan LIC610A, PUB394 Notification of Parents Rights Poster, and Facility License) on Parent Boards in the living room.

Staff Forms/Records - any assistant must have the following on file before working in the facility:

· Proof of TB clearance (within one year)

· Immunization records

· Notice of Employee Rights (LIC 9052)

· Criminal Record Statement (LIC 508)

· Statement Acknowledging Requirements to Report Suspected Child Abuse (LIC 9180)

Children’s records requirements: LIC 700 Identification And Emergency Information, LIC 627 Consent For Emergency Medical Treatment, LIC 282 Affidavit Regarding Liability Insurance, LIC 9150 Parent Notification Additional Children In Care, Immunization record, PUB 72- Family Child Care Consumer Guide, LIC 995A Notification of Parent’s Rights

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

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

DATE: 08/08/2025
LIC809 (FAS) - (06/04)
Page: 4 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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: VARGAS FAMILY CHILD CARE
FACILITY NUMBER: 198021633
VISIT DATE: 08/08/2025
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  • A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.
· The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked and batteries replaced as needed.
· Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.
· Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.
· Mandated reporter requirements were reviewed and explained.
· Fire and safety drills must be performed every 6 months and documented for review by the Department.
· Smoking is prohibited in a family child care home, 24/7.
· Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
· No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.
· All adults living and working in the home shall be made of aware of the Departments right to inspection authority.
LPA advised applicant to refer to Section 101173 and 101226 for further information on regulatory requirements. Regulation Interpretations and Procedures for Child Care Centers Section 102417. 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: http://www.ada.gov/childqanda.htm.

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

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

DATE: 08/08/2025
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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: VARGAS FAMILY CHILD CARE
FACILITY NUMBER: 198021633
VISIT DATE: 08/08/2025
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LPA Ruiz informed Licensee that corrections needed for this facility to be licensed as a large family child care home are:

· Adult(s) living in ADA must be fingerprinted and associated to your facility license.

· Submit immunization records for assistants.

LPA Ruiz informed Licensee Sandra Vargas that she may begin operating as a large family child care home after the application has been reviewed and approved by the Monterey Park Child Care office.

Exit interview conducted with applicant Sandra Vargas. Appeal rights discussed and explained.

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

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

DATE: 08/08/2025
LIC809 (FAS) - (06/04)
Page: 6 of 6