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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400586
Report Date: 07/11/2025
Date Signed: 07/11/2025 04:19:20 PM

Document Has Been Signed on 07/11/2025 04:19 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:NORMAN FAMILY CHILD CAREFACILITY NUMBER:
198400586
ADMINISTRATOR/
DIRECTOR:		ROBIN NORMANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 658-9658
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY: 14TOTAL ENROLLED CHILDREN: 16CENSUS: 0DATE:
07/11/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:40 PM
MET WITH:ROBIN NORMAN / LICENSEE and Facility Representative KOLISHA WILLIAMS-GREER TIME VISIT/
INSPECTION COMPLETED:
04:25 PM
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On 07/11/25, Licensing Program Analyst (LPA) Ashley Calderon conducted an annual/ random inspection for the above address. Upon arrival individual adult greeted LPA Calderon, LPA asked if there were any day care children present and LPA asked if Licensee Robin Norman was available. LPA was informed LPA needs to speak with R.Norman. Per individual adult, Licensee via telephonically was called to inform Licensee about LPA's arrival. LPA was informed by R.Norman children come in the evening, no day care children at the home and can meet up with LPA shortly. At approx 1:00 pm Licensee R.Norman arrived at the facility and allowed LPA entrance into the home. R.Norman guided LPA on a tour of the facility. LPA observed (0) children present in the home. Per Licensee, hours of operation will be Monday through Sunday, 12:00 am to 11:57 pm . Licensee was informed a child can not exceed 24 hour care at one time. Licensee care for children 0-18 years of age. Entrance Checklist was provided. Per R.Norman no infants in care. LPA reminded Licensee temporary absence shall not exceed 20% of the hours of operation. This is a two-story home which consists of 5 bedrooms (all upstairs), 4 bathrooms, classroom/den, kitchen, dining room, living room, garage, front and backyard. 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. Areas used by children include: classroom/den, living room, bathroom located in the living room, and backyard. Areas off limits include: All of upstairs which include 5 bedrooms and 3 bathrooms, kitchen, dining room, garage, and front yard. The off limit areas are inaccessible. The stairs are gated when children 5 and under are present. There is a fountain in the front yard; Licensee has previously removed the water and signed a declaration stating the fountain will always be empty and children are not allowed in the front yard alone. Front yard is only used for drop off and pick up. (Pg 1/ Cont...)
NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2025
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: NORMAN FAMILY CHILD CARE
FACILITY NUMBER: 198400586
VISIT DATE: 07/11/2025
NARRATIVE
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The licensee provides food for children in care. Licensee was reminded if children bring food from home it must be labeled with the child’s name and properly stored or refrigerated.

Individuals residing in the home have been discussed and noted. All adults present in the home have obtained a criminal record clearance or exemption (if applicable).

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection:

LPA reviewed required posted documentation (posted by the fireplace) for Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. Facility records were reviewed for LIC 9040- Facility Roster roster was observed incomplete, deficiency cited, LIC 610- Facility Disaster Plan and Disaster drill log, last drill conducted on 1/13/25, LPA reminded to conduct drills every 6 months.

Smoke and carbon monoxide detectors were tested and are operable. The 2A10BC fire extinguisher was fully charged and there is a service tag dated April 2025. The home maintains telephone service via landline and cell phone. There are toys and other age appropriate material available for children. LPA observed that detergents, cleaning compounds and medication are kept in hallway cabinets or in locked pantry and was inaccessible to children. Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, not only inaccessible to children. Isolation area for sick children waiting to be picked up near the front door, away from the other children. Per Licensee there are no firearms or weapons stored in the home.

Currently, children are using the back yard for outdoor play. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with and no bodies of water was observed on premises. LPA' did not observe any objects that could be hazardous to children in care. Per Licensee provides transportation to children in care.

(Pg 2/ Cont...)
NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2025
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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: NORMAN FAMILY CHILD CARE
FACILITY NUMBER: 198400586
VISIT DATE: 07/11/2025
NARRATIVE
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Five (5) children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunizations Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights. Consultation given regarding thoroughly filling out forms for child #3, #4 and #5.

Staff records were reviewed, Licensee and (2) staff assistants files. Licensee's first aid is valid and Mandated Reporter is in progress per Licensee website is glitching. Documents reviewed: Staff Assistants #1 (S1) file had a Mandated Reporter certificate expires 9/12/26. S1 file missing and not provided: immunization (mmr. tdap, tb ) records/ LIC 9108 Statement of Reporting Child Abuse missing and no LIC9052 employee rights in staff file.

Staff #2 first aid / cpr not valid- no EMSA stickers and from American Health Care Academy Company needs to be a EMSA vendor agency, therefore informed Licensee can't stay alone with children until fully qualified , in addition S2 is missing in file: immunization (mmr& tdap )records ,LIC 9108 Statement of Reporting Child Abuse , missing LIC9052 Employee Rights and expired mandated reporter training, deficiencies cited.
  • Facility Representative 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 Facility Representative 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.

(Pg 3/ Cont...)
NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2025
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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: NORMAN FAMILY CHILD CARE
FACILITY NUMBER: 198400586
VISIT DATE: 07/11/2025
NARRATIVE
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  • 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/.
  • Facility Representative 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 Facility Representative KOLISHA WILLIAMS-GREER confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Facility Representative KOLISHA WILLIAMS-GREER.

(Pg 4/ End of Report)

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

DATE: 07/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2025
LIC809 (FAS) - (06/04)
Page: 5 of 8
Document Has Been Signed on 07/11/2025 04:19 PM - It Cannot Be Edited


Created By: Ashley Calderon On 07/11/2025 at 03:01 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: NORMAN FAMILY CHILD CARE
FACILITY NUMBER: 198400586

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/11/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA Calderon's observation fireplace had a collapsable screen and a metal screen both aren't screened off and children can access fireplace , the licensee did not comply with the section cited above in [1] out of [1] fire place which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/28/2025
Plan of Correction
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Make fireplace inacessible to children in care, send picture to LPA Calderon by poc due date.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA Calderon's observation during record review Staff assistant #2 mandated reporter exp 3/19/25 and Licensee's training is in progress due to glitching website unable to complete, the licensee did not comply with the section cited above in [2] out of [2] staff assistant mandated repoter certficate which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/11/2025
Plan of Correction
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Licensee and Staff Assistant #2 will complete mandated reporter training can use CAMandatedReporter website or contact Union and send certficates to LPA Calderon by poc due date.
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: 07/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/11/2025 04:19 PM - It Cannot Be Edited


Created By: Ashley Calderon On 07/11/2025 at 03:01 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: NORMAN FAMILY CHILD CARE
FACILITY NUMBER: 198400586

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/11/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.1(a)(10)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information: (10) A signed and dated copy of the Notice of Employee Rights [LIC 9052, (Rev. 03/03)] as required by Section 102416(a) and Section 102417.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA Calderon's observation during record review staff assistant #1 and #2 did not have LIC9052 Employee Rights in file, the licensee did not comply with the section cited above in [2] out of [2] staff records incomplete which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/28/2025
Plan of Correction
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Licensee will have Staff Assistants complete: LIC 9108 Statement of Reporting Child Abuse and LIC9052 employee rights forms and submit to LPA Calderon by poc due date.
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 oLPA Calderon observation during record review staff assistant #1 and #2 missing immunization records, Staff #1 missing mmr. tdap, tb and Staff #2 missing mmr and tdap record, the licensee did not comply with the section cited above in [2] out of [2] immunization records which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/11/2025
Plan of Correction
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Staff #1 will obtain mmr. tdap, tb records / vaccination and Staff #2 will obtain mmr and tdap record and copies of immunization records will be sent to LPA Calderon by poc due date.
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: 07/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/11/2025 04:19 PM - It Cannot Be Edited


Created By: Ashley Calderon On 07/11/2025 at 03:01 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: NORMAN FAMILY CHILD CARE
FACILITY NUMBER: 198400586

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/11/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA Calderon observation during record review, Children's Roster-LIC9040 is missing information on children listed, the licensee did not comply with the section cited above in [1] out of [1] Children Roster which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/28/2025
Plan of Correction
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Children's Roster-LIC9040 will be completed and Licensee will submit photo of roster 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: 07/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2025


LIC809 (FAS) - (06/04)
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