198400447-9-22-2025-54-CC-FWHE-DLS2QP-20250922173617

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400447
Report Date: 09/22/2025
Date Signed: 09/22/2025 05:36:35 PM

Document Has Been Signed on 09/22/2025 05:36 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:	RUBIO FAMILY CHILD CARE		FACILITY NUMBER:	198400447
ADMINISTRATOR/ DIRECTOR:	ELMA RUBIO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 517-3951
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90062
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 1	DATE:	09/22/2025
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:45 AM
MET WITH:	Elma Rubio, Licensee		TIME VISIT/ INSPECTION COMPLETED:	03:30 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	Licensing Program Analyst (LPA) Franchesca White arrived at the above facility for the purpose of an unannounced 3yr. Required - Annual inspection. LPA White announced the purpose of the visit and was grant entry into the facility by Licensee Elma Rubio. The hours of operation are 6:00 a.m. to 6:00 p.m. (Monday to Friday). The ages of the children served at this facility are infant to 12 years of age. There are 6 children enrolled and 1 present at the time of inspection. All adult in the home were discussed and have current criminal background clearance. The following documentation was observed on the parent board and/or available at the time of inspection: License, Parent's Rights, Emergency Disaster Plan, and the Disaster drill log reflects that the last drill was conducted 7/1/2025. The facility roster was available and current at the time of inspection. All life saving devices were inspected and were found to be operable at the time of inspection. The 2A 10BC fire extinguisher was fully charged and had a service tag / purchase tag dated 8/16/2025. It is located in the dining room of the home. The Smoke / Carbon Monoxide Detector is located in the activity room . Licensee states that the kitchen area nearest the door is set up with a chair or a cot depending on the illness will be used as an isolation space for sick children waiting to be picked up by a parent or guardian. There is a working telephone in the home. This is a single story home which consists of 3 bedrooms, 1 bathroom, kitchen, living room, and laundry room. The home is located in the rear of a two-unit property. Licensee states that the areas accessible to children are the Two bedrooms, bathroom, living room, kitchen and dining are, yard space in front of both units. Areas off limits to children during the hours of operation are Bedroom 2, . ............Report Continues 1 of 4 Pages.......

NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Franchesca White
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2025

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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: RUBIO FAMILY CHILD CARE	FACILITY NUMBER: 198400447
	VISIT DATE: 09/22/2025

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Laundry room in kitchen, back and sides of home, 2 storage units located on the side of the home between the 2 units. LPA observed gates on either side of home making the side and back of home inaccessible.

LPA White observed the living room space to have a couch and flat screen mounted tv. Licensee states that the living room is used for napping children, and added space for children to play when there are children in the activity room located in the rear of the home.

LPA White observed the off limits bedroom to be made in accessible with the use of a child safety lock. LPA White observed the dining room to have a round table with three chairs, and a large flat screen tv mounted to the wall. There is a changing table with toileting supplies stored on the shelves under the table. There is a play pen in the corner for a sleeping infant. There is a counter island with two bar high chairs that separate the dining room from the kitchen. LPA White observed the kitchen to have a baby gate that makes the kitchen area of the home in accessible to children in care during hours of operation. Licensee states that knives are kept in a locked drawer making them inaccessible to children in care.

LPA White observed the activity room (bedroom 3) to have dramatic play items along the wall with bookcases with resources for the children such as activity books, and reading development books. There are storage containers filled with dolls, and items for dramatic play on the shelves. There is an age - appropriate table with chairs for the children. Licensee states that children take their meals in the activity room. There are folding cots stored behind the door of the activity space.

LPA White observed the large bathroom to have one toilet, one sink, one shower/tub. All cabinets under the sink have child safety locks making them inaccessible to children in care. LPA White did not observe any flooring hazards or debris in the clean bathroom. There was hand washing supplies, paper towels, and toilet paper.

LPA White observed the outdoor play area to be between the front and rear home with toys for play. There is a play area in the front of first home where the children have a play jungle gym and balls to play. The entire perimeter of the home is completely fenced in with a gate that requires a code for entry to the property.

...............................................................Report Continues 2 of 5 Pages................................................

NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Franchesca White
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2025

LIC809 (FAS) - (06/04)

Page: 3 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: RUBIO FAMILY CHILD CARE	FACILITY NUMBER: 198400447
	VISIT DATE: 09/22/2025

NARRATIVE

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LPA White observed a gate on the left side of the rear home that makes the backyard inaccessible to children in care during hours of operation. Licensee states that she has four dogs in the backyard that are kept there during the hours of operation.

Licensee states that there are no bodies of water. LPA White did not observe any bodies of water. Licensee states that there are no weapons or firearms in the home. LPA White did not observe any weapons or firearms in the home.

LPA White reviewed staff file for licensee Elma Rubio to have all department required documentation and immunization records available the time of inspection. The following training and certifications were reviewed and are current: Mandated Reporter Training: 7/15/2025 ( expires 7/2027); CPR/First Aid: 8/27/2024 (expires 8/2026). Staff 1 (S1) has Mandated Reporter Training: 7/15/2025 (7/2027); CPR/First Aid: 8/27/2024 (expires 8/2026).

LPA White reviewed the children's files and immunization records. All files had department required documentation. LPA White provided technical assistance and consultation with Licensee on regulation and best practice for maintaining files and the immunization requirement for child care children. LPA White will provide licensee with 15 minute log sheet for infants. LPA White observed the file for the infant to have proper sleeping plan at the time of inspection.

During consultation LPA White discussed the importance and best practice of Licensee having a parent contract and updating emergency contact information on an annual basis. LPA White will provide Licensee with a Fire and Disaster Drill Log form. LPA White commended Licensee for being resourceful and using spiral notebooks to record drill information, as well as infant 15 minute sleep logs for the infants in care. LPA White will provide the above said documents on or before October 1st.

The following were discussed:
All areas used by children were inspected for safety, comfort, cleanliness, telephone service (cell phone), ventilation and heating (central air and heat).

.............................................Report Continues 3 of 5 Pages................................................................

NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Franchesca White
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2025

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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: RUBIO FAMILY CHILD CARE	FACILITY NUMBER: 198400447
	VISIT DATE: 09/22/2025

NARRATIVE

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Licensee Elma Rubio was reminded that all adults 18 and over, 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 Child Care Center. 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 Elma Rubio 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 Elma Rubio 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 Elma Rubio 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.

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

Based on today's interviews, observations, and record review, there will be no deficiencies cited in accordance with California Title 22 Regulations.

. ......Report Ends 4 of 5 Pages....

NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Franchesca White
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2025

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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: RUBIO FAMILY CHILD CARE	FACILITY NUMBER: 198400447
	VISIT DATE: 09/22/2025

NARRATIVE

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A notice of site visit was given and must remain posted for 30 days. Failure to post will result in a civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Licensee Elma Rubio. PIN 22-05-CCP Page Six

A copy of the report and appeal rights was given to Licensee Elma Rubio

.............................................................Report Ends 5 of 5 Pages................................................................

NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Franchesca White
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2025

LIC809 (FAS) - (06/04)

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