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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400630
Report Date: 03/26/2026
Date Signed: 03/26/2026 03:20:10 PM

Document Has Been Signed on 03/26/2026 03:20 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:SHIRLEY FAMILY CHILD CAREFACILITY NUMBER:
198400630
ADMINISTRATOR/
DIRECTOR:		LILLIAN A.E. SHIRLEYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 228-9048
CITY:LOS ANGELESSTATE: CAZIP CODE:
90003
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 2DATE:
03/26/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Lillian Shirley, LicenseeTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Franchesca White arrived at the above facility for the purpose of an unannounced annual random inspection. LPA White announced the purpose of the visit and was granted entry to the facility by Licensee Lillian Shirley. There are 2 children enrolled, and 2 present at the time of inspection. There are 1 adults in the home and 1 out 1 have current criminal background clearance. The ages of the children served in this home are infant to 12 years of age. The hours of operation are 24 hours (Monday - Saturday)

The following documents were observed on the Parents Board and/or available at the time of inspection:

the License, Parents Rights, Emergency Disaster Plan, Earthquake Preparedness, Disaster Drill Log with more recent drill conducted 3/19/2026, and the facility Roster was current at the time of inspection.

All life saving devices were inspected and found to be operable at the time of inspection. The 2A 10BC full charged Fire extinguisher is located in the main care space (living room) with a service tag dated for 12/1/2025. The smoke detector is located on the ceiling of the main care space. The carbon monoxide detector is located on the wall above the entrance to the kitchen. The isolation area for a sick child waiting to be picked up by a parent/guardian is an area of the living room not being used by the day care children. There is a working phone in the home.

All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a single story home that consists of three bedrooms, one bathroom, living room, dining room, kitchen, laundry area, front yard (fenced) and back yard. Off limit areas include three bedrooms, laundry area and backyard .


(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: 03/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/23/2026
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: SHIRLEY FAMILY CHILD CARE
FACILITY NUMBER: 198400630
VISIT DATE: 03/26/2026
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Main care area was inspected for the health, safety, comfort, and proper ventilation for the children in care. LPA White observed The main care area of the home is the Living room. The living room has two couches and a mounted tv high above a non-operational fireplace. At the entrance of the home there is a pull fire alarm to the right. . Licensees state that this space is used primarily for napping, and indoor activity play. There is book center located under the window. There are age appropriate toys and games stored in storage bins, and stacked in cubbie-like containers. There is a pack'n'play pen against the wall, and a changing table next to the play pen. there are two area rugs covering the carpeted floor with numbers, alphabets, shapes and colors.

LPA White observed the kitchen to be made inaccessible to children in care with the use of a baby gate Licensee states that children take their meals in the main care space at the child size table located near the storage cabinet. Storage cabinet was observed to have a child lock on it.

LPA White observed the bathroom to have one sink, one toilet, and a shower. There is handwashing items, and toilet paper for the children. LPA White did not observe any slipping hazards, or debris on the floors.

LPA White observed the outdoor play area to be in the front yard with a fully fenced perimeter. There are age appropriate toys for day care children. There is a baby gate separating the driveway from the grassy play area for the children.

Licensee states that there is 1 dog in the home. LPA White observed 1 dog in the home. Licensee states that there are no bodies of water around the home. LPA White did not observe any bodies of water around the home. Licensee states that there are no guns or weapons in the home. LPA White did not observe any weapons or firearms in the home.

LPA White reviewed the 1 staff files. 1 out of 1 staff files had the required department documentation available for review at the time of inspection. Immunization records for 1 out 1 staff were available for review at the time of inspection. (Available documents noted on LIC 859)

LPA White reviewed 2 children's files. 2 of 2 children’s files had the required department documentation available for review at the time of inspection.

(Report Continues 2 of 4 Pages)

NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Franchesca White
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2026
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: SHIRLEY FAMILY CHILD CARE
FACILITY NUMBER: 198400630
VISIT DATE: 03/26/2026
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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).

Licensee Lillian Shirley 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 Lillian Shirley 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 Lillian Shirley 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 Lillian Shirley 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 Lillian Shirley, 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. Failure to post will result in a civil penalty of $100.

(Report Continues 3 of 4 Pages)

NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Franchesca White
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2026
LIC809 (FAS) - (06/04)
Page: 4 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: SHIRLEY FAMILY CHILD CARE
FACILITY NUMBER: 198400630
VISIT DATE: 03/26/2026
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Based on today's observations, record review, and interviews there will be no deficiencies cited in accordance with California Title 22 regulations.

Exit interview conducted and report was reviewed with the licensee Lillian Shirley. PIN 22-05-CCP Page Six

A copy of the report and appeal rights was given to Licensee Lillian Shirley.

(Report Ends Here 4 of 4 Pages)

NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Franchesca White
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2026
LIC809 (FAS) - (06/04)
Page: 5 of 5