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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400889
Report Date: 04/03/2025
Date Signed: 04/03/2025 03:58:14 PM

Document Has Been Signed on 04/03/2025 03:58 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:WILCOX FAMILY CHILD CAREFACILITY NUMBER:
198400889
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 13CENSUS: 4DATE:
04/03/2025
TYPE OF VISIT:Annual/RandomANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:TONIQUE WILCOX / LICENSEETIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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On 4/3/25, at 12:35pm Licensing Program Analyst (LPA) Ashley Calderon conducted an announced visit to evaluate a capacity increase of 14 max. In addition, LPA conducted a random/annual inspection to the above facility. Upon arrival LPA was greeted by Licensee Tonique Wilcox who allowed entrance into the facility. LPA disclosed the purpose of today's visit.

Upon entrance LPA observed Licensee, Staff #2 and 2 infants in care. Facility has an approved fire clearance was approved on 03/07/25. Facility Operation Hours are Monday-Friday 5am-11pm, and Saturday and Sunday 5am-4pm and cares for Children Ages 3 months - 12.5 years old.

Licensee T.Wilcox guided analyst on a tour of the facility. LPA observed on adult individual that resides in the home present during visit. A current children’s roster was available for review. All staff/ residents have been verified and adults have a criminal record clearance. At 1:20pm additional children arrived at the facility.

This is a one-story home which consists of 3 bedrooms, 2 bathrooms, kitchen, dining room, living room, detached garage, front yard and backyard (fenced). Per Licensee, on limits areas consist of: living room, hallway to (2) bathrooms, dining room (infant area), front and back yard. Passage way is the laundry room to the backyard. Off limits areas are (3) bedrooms, kitchen and detached garage. LPAs observed off limit area bedrooms have baby safety knobs.

Kitchen was observed with a baby safety gate at the entrance to provide inaccessibility. Cabinets have baby safety latches. Knives are located in kitchen cabinet with a latch and cleaning solutions/ chemicals are stored under kitchen sink with a latch. The licensee provides food for children in care. (Cont..)
NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/03/2025
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: WILCOX FAMILY CHILD CARE
FACILITY NUMBER: 198400889
VISIT DATE: 04/03/2025
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Licensee states that there are no firearms stored in the home and no children on medication. Licensee stated has a dog, dog remains in an off limit bedroom and does not associate with children until it gets trained.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There is telephone service via a cellphone that is used. There is ventilation and heating. Licensee uses ceiling fan in the living room. Safe toys play equipment and materials were observed. LPA observed wall heater in the living room screened off half way from the ground to the mid area, consultation provided. LPA advised to place screen protector higher to prevent after school children from reaching heater. LPA advised that if a child shows signs of illness they shall be separated from other children. Per Licensee, poison like 'Raid' is stored in the locked garage, LPA observed locked garage door located in the backyard that uses key. The (2) restroom that children use was observed to be safe and sanitary.

LPA observed 2A10BC fire extinguisher located in kitchen area and inspected on 12/20/24. Emergency Disaster Log was reviewed and drill conducted and dated on 2/3/25. LPA observed fire pull system, smoke alarm and carbon monoxide detectors located in hallways and properly operating. Children are using the front yard and back yard for outdoor play time. The outdoor play area was observed to be fenced in both play areas and have children toys/equipment. LPA observed no bodies of water.

LPA reviewed staff records. The licensee's Pediatric First Aid and CPR expires on 7/31/25 and Mandated Reported expires on 9/18/25. Staff #2 was missing records of TB clearance, deficiency cited. Staff #2 Mandated reporter Training expires 3/15/27. Volunteer, resident living in the home during visit was not left alone with children, Volunteer has fingerprints and has a valid Pediatric First Aid and CPR exp 9/24/26 and is in the process of getting their Mandated reporter training to become an assistant staff. (4) children records was reviewed all files had appropriate documentation's. Infants had 15 min sleep log and Infant #1 has LIC9227 Individual Infant Sleep Plan due age. LPA conducted staff interview with Licensee.

(cont..)
NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2025
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: WILCOX FAMILY CHILD CARE
FACILITY NUMBER: 198400889
VISIT DATE: 04/03/2025
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  • LPA discussed the safe sleep regulations with the 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.
  • LPAs 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.
  • Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
  • Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm
  • 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.

During the exit interview, the Licensee Tonique Wilcox confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO in FAS. Based on today’s visit, Per California Code of Regulations Title 22 there was one deficiency cited, provided on LIC 809-D. Appeal Right were provided.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days.

A Large Capacity Increase License would be issued upon the department's approval. Exit interview was conducted and report reviewed with the Licensee, Tonique Wilcox
NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/03/2025 03:58 PM - It Cannot Be Edited


Created By: Ashley Calderon On 04/03/2025 at 03:09 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: WILCOX FAMILY CHILD CARE
FACILITY NUMBER: 198400889

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/03/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102369(9)
Application for Initial License
(9) Evidence of a current tuberculosis clearance, not more than one year prior to or seven days after initial presence in the home, for any adult in the home during the time that children are under care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA Calderon observation during record review Licensee was unable to provide Staff #2 Tuberculosis (TB) records, Per Licensee during interview stated thought TB was only needed for Adults Living in the Home, the licensee did not comply with the section cited above in [1] out of [1] staff assistant/ Staff #2 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/18/2025
Plan of Correction
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Licensee will have Staff #2 get immunization against TB and provide records to LPA Calderon via email 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: 04/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/03/2025


LIC809 (FAS) - (06/04)
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