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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400273
Report Date: 09/18/2025
Date Signed: 09/18/2025 02:17:29 PM

Document Has Been Signed on 09/18/2025 02:17 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:LAGUNAS FAMILY CHILD CAREFACILITY NUMBER:
198400273
ADMINISTRATOR/
DIRECTOR:		MAYRA L. LAGUNASFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 399-8040
CITY:LOS ANGELESSTATE: CAZIP CODE:
90061
CAPACITY: 14TOTAL ENROLLED CHILDREN: 13CENSUS: 10DATE:
09/18/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:MAYRA L. LAGUNAS/ LICENSEETIME VISIT/
INSPECTION COMPLETED:
02:25 PM
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 ***VISIT CONDUCTED IN SPANISH****
Licensing Program Analyst (LPA) Ashley Calderon, conducted an unannounced Annual Random Inspection and met with Licensee Mayra Lagunas who allowed LPA entrance into the facility. LPA discussed purpose of today's visit.

Hours of operation are from Monday to Friday, 7:00 AM to 5:00 PM. LPA toured the home inside and outside and a census was taken. Upon arrival LPA observed 10 children in care, 3 whom were infants. LPA observed 2 staff assistants and Licensee present, all individuals working and residing in the home are fingerprinted cleared.

This one single story home which consists of four bedrooms and two bathrooms. On limits: living room, kitchen, one bathroom, one room used as infant room and nap room, one open space next to the infant room identified as the toddler room and nap room, the front yard and backyard. Off limits include: 3 bedrooms, one bathroom and, laundry room .

The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. LPA noted space with age-appropriate toys inside and outside. LPA observed wall heater located in the living room with a metal barricade. LPA observed fire extinguisher with service tag dated 2/2025. During inspection, LPA observed cleaning supplies located in off-limits laundry room secured by screen barrier on a high shelf inaccessible to children in care. Licensee, there are no weapons or firearms at the home; LPA did not observe any firearms or weapons at the time of the inspection.

NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/18/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: LAGUNAS FAMILY CHILD CARE
FACILITY NUMBER: 198400273
VISIT DATE: 09/18/2025
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Per licensee, outdoor play is conducted in the backyard. LPA observed backyard is fenced and fully enclosed. LPA observed no hazards in outdoor play area and no bodies of water was observed.

In the backyard were primary care takes place, the required posted documentation's were observed. Facility Roster and PUB Notification of Parent Rights form. LPA provided LIC9148 Earthquake Preparedness Checklist to post. LPA Calderon reviewed Fire and Disaster Drill log, last conducted Aug 14, 2025.

LPA observed laundry room is where detergents are stored and hazardous tools are located in this area, the area is off limits in the hallway area with a baby gate in place.

On today's date carbon monoxide and smoke alarm devices were not tested due to napping children. LPA informed Licensee to add a night light in children's room to prevent any incidents from occur and for safety.

The home provides food for the children in care. Cleaning compounds and solutions was observed under the kitchen sink with magnetic lock, this area is were poisons are stored, home contains Raid Ant and Roach Killer, consultation given.

If ill child showing signs of sickness, child waiting to be picked up by parents will be separate from other children waiting in room that is not occupied by the children either in one of the bedrooms or in a far area away from children when outside space is being used.

LPA observed play yard for infant child, per Licensee two other infants present transitioned into a cots. Infant in play yard was observed on back, on a firm mattress and fitted sheet. Infant had no loose items / blankets in play yard when sleeping. LPA informed Licensee and staff assistant to maintain door that leads to hallway open when children are napping and if staff are not visibly observing children. Home maintains monitor devices in napping bedrooms. LPA observed a baby rocker, LPA informed Licensee not remove it from facility and not to use items like baby walkers, baby swings and jumpers and similar items.

Children records were observed (5) files were reviewed; documents were in place, files had Emergency contacts and information and immunization records. LPA consulted on Immunization records to update records yearly and to have PM286 California Immunization Records form. Staff records were reviewed Licensee file and two staff assistant whom were present during today's visit. Licensee Mandated Reporter certification expires 1/16/2027 and Pediatric 1st aid and cpr expires 9/29/2025. Staff assistants had valid Mandated Reporter training and 1st aid and cpr. Staff #2 had TB in file and was missing records for MMR and TDAP, deficiency cited. Staff interview was conducted with Licensee.

NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 09/18/2025 02:17 PM - It Cannot Be Edited


Created By: Ashley Calderon On 09/18/2025 at 01:15 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: LAGUNAS FAMILY CHILD CARE
FACILITY NUMBER: 198400273

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review Staff #2 file and immunization record was not provided for MMR and TDAP, the licensee did not comply with the section cited above in [1] out of [1] staff immunization records incomplete which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/17/2025
Plan of Correction
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 Staff #2 will obtain vaccine if needed or will get immunization record and copy will be sent to LPA Calderon by poc due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Denise Gibbs
NAME OF LICENSING PROGRAM MANAGER:
Ashley Calderon
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2025


LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: LAGUNAS FAMILY CHILD CARE
FACILITY NUMBER: 198400273
VISIT DATE: 09/18/2025
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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, 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.
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-and-resources/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. 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.

Per California Code of Regulation Title 22, facility was cited one deficiency on today's visit, listed on LIC809-D page. A notice of Site visit was provided and must be posted for 30 days. An exit interview was conducted with Licensee Mayra Lagunas.

NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
LIC809 (FAS) - (06/04)
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