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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400529
Report Date: 07/22/2026
Date Signed: 07/22/2026 01:23:26 PM

Document Has Been Signed on 07/22/2026 01:23 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:ROSALES VILLAGRANA FAMILY CHILD CAREFACILITY NUMBER:
198400529
ADMINISTRATOR/
DIRECTOR:		ROSALES VILLAGRANA, MARTHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 348-9090
CITY:LONG BEACHSTATE: CAZIP CODE:
90810
CAPACITY: 14TOTAL ENROLLED CHILDREN: 17CENSUS: 17DATE:
07/22/2026
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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Licensing Program Analyst conducted an unannounced Case Management facility visit to the above home. The purpose of the visit was to inspect back home since licensee stated might be removed from facility sketch. LPA arrived at 11:10 am and was met by Facility representative Martha Carrillo Rosales (A1). The licensee arrived at 11:15 and allowed LPA to enter home. LPA observed A1 alone with 10 children including 3 infants.

At 11:22 LPA inspected the detached backhouse, which is used as a playroom. LPA observed Adult 2, Assistant, in the living room of the backhouse. A2 left the home shortly after LPA arrival. At 11:23 LPA requested licensee open the bedroom door of backhouse, LPA observed 7 children come out of bedroom.


The facility had a total of 17 children in care including 3 infants, posing an immediate risk to the children in care.

LPA observed Adult 4, Jamie Gonzalez was in the bedroom with the 7 children. Record review shows that A4 does not have a background clearance and supervising children in care which poses an immediate risk to the health and safety of children in care. Per licensee, A4 has been helping in the daycare for 2 days, a $200 civil penalty is assessed on this date.

During this visit the licensee was provided technical assistance in updating facility sketch, completing livescan form, and capacity limitation of the license.

During this visit 4 children were picked up by their Authorized Representative, bringing the facility in compliance with the license capacity. Adult 4 left the facility, per licensee they will not return until they obtain the required background clearance.

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Warren Birks
Alicia Mooberry
DATE: 07/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2026
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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: ROSALES VILLAGRANA FAMILY CHILD CARE
FACILITY NUMBER: 198400529
VISIT DATE: 07/22/2026
NARRATIVE
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Based on the LPA's observations and records review 2 A deficiencies will be cited today in accordance with California Title 22 Regulations.

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form (LIC 9224) during this visit. The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent.

A notice of site visit was given and must remain posted for 30 days. Appeal Rights were discussed and provided.

Exit interview conducted and report was reviewed with the licensee Martha Villagrana.

NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Alicia Mooberry
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2026
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 07/22/2026 01:23 PM - It Cannot Be Edited


Created By: Alicia Mooberry On 07/22/2026 at 12:26 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: ROSALES VILLAGRANA FAMILY CHILD CARE
FACILITY NUMBER: 198400529

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/22/2026
Section Cited
CCR
102416.5(a)(f)

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(a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.(f) The total licensed capacity for a Large Family Child Care Home shall not exceed fourteen children.
This requirement is not met as evidenced by:
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Deficiency corrected during visit, parents of children picked up children, bringing license into capacity. Per licensee, a detailed schedule of children in care and the days and hours they attend will be provided to the department by 7/31/26.
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Based on LPA observation and Licensee interview, 17 children ranging from ages 8months-8 years were present in the home during this inspection posing an immediate risk to the health and safety of children in care.
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Type A
07/22/2026
Section Cited
CCR102416(d)(1)

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Prior to employment or initial presence in the child care home, all employees and volunteers subject to a criminal record review shall: Obtain a California clearance or a criminal record exemption as required by law or Department regulations...
This requirement is not met as evidenced by:
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Deficiency corrected during visit. Per licensee, Adult 4 will not be present during daycare hours until they have obtained the required background clearance
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Per LPA observation, record review and licensee interview, Jaime Gonzalez (Adult 4) was present in the home and provided supervision to children in care without first obtaining background clearance, posing an immediate risk to children in care. A $200 Civil penalty is assessed on this date.
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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.
Warren Birks
NAME OF LICENSING PROGRAM MANAGER:
Alicia Mooberry
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/22/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2026


LIC809 (FAS) - (06/04)
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