198400950-10-17-2025-54-CC-ACAN-DMJULJ-20251017154049

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400950
Report Date: 10/17/2025
Date Signed: 10/17/2025 03:41:08 PM

Document Has Been Signed on 10/17/2025 03:41 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:	VILLALTA AGUILAR FAMILY CHILD CARE		FACILITY NUMBER:	198400950
ADMINISTRATOR/ DIRECTOR:	VILLALTA AGUILAR, DORIS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 714-5975
CITY:	CARSON	STATE: CA	ZIP CODE:	90746
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 6	CENSUS: 1	DATE:	10/17/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:33 PM
MET WITH:			TIME VISIT/ INSPECTION COMPLETED:	03:47 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	CONDUCTED IN SPANISH Licensing Program Analyst (LPA) Ashley Calderon arrived at the facility for an unannounced annual/random inspection. LPA met with Licensee, Doris Villalta Aguilar who allowed LPA entrance into the facility. LPA discussed purpose of today's visit. LPA provided Facility Checklist LIC126. Upon arrival LPA observed 1 infant in care. Hours of operation will be Monday- Sunday from 12:00AM- 11:59PM. Per Licensee, is open for overnight care but currently no children are overnight care. LPA Calderon at 1:45pm spoke via telephonically to Support Staff at MPSW in regards to account balance from the previous license. LPA was provided by Licensee confirmation for current Licensee , paid date 2/28/2025. LPA discussed individuals residing in the home were noted and found fingerprinted cleared and Licensee informed LPA of changes of the home sketch, home added an ADU with the same address as above, deficiency cited as changes in the physical plant was not reported to the department. The facility is a one-story home that consists of 3 bedrooms, 1 bathroom, living room, kitchen/dining room, and garage. LPA toured the whole facility. On limit areas are: 1 bedroom, bathroom, living room, kitchen (as a walkway only), and backyard. Off limit: garage , 2 bedrooms and ADU. Licensee understands that off-limit area are to be locked and inaccessible to children. The following was inspected for comfort, safety and cleanliness: (Pg 1)

NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025

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: VILLALTA AGUILAR FAMILY CHILD CARE	FACILITY NUMBER: 198400950
	VISIT DATE: 10/17/2025

NARRATIVE

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LPA observed areas used by children observed to be safe and no hazards; LPA observed age appropriate toys and materials for children in care.

LPA in the hallway observed in the wall heater a wall heater with a barricade only screened off towards the bottom half, LPA informed Licensee if any children enrolled can touch the wall heater directly to add a screen in the top portion of the wall heater. During the visit, LPA observed carbon monoxide and smoke alarm, interconnected, tested and found operable. LPA observed a fire extinguisher with receipt dated 1/31/25. LPA reviewed Disaster and Fire Drill, last conducted 10/6/2025.

Backyard was observed and no bodies of water observed on premises.

Cleaning supplies are observed to be under the kitchen sink with a magnetic fob, cabinets observed locked. Knives and sharps are located in a cabinet in the kitchen with a magnetic fob in place. Per Licensee, poisons are stored in the locked garage.

Licensee will update the Application LIC279 due to Licensee D.Villalta informed LPA Calderon an additional adult living that lives in the home; and is fingerprinted, LPA per record review from Guardian Roster observed individual is fingerprinted cleared, deficiency cited as change was not reported to the department when adult moved in back in 8/2024. Licensee in addition, will update Current Children Living in the home -LIC279B. Per Licensee, Currently (2) children living in the home, new child lives in the ADU and one in the front home. Child in the front home due to age does not count in census. During visit Licensee provided LPA Calderon with a updated Facility Sketch for back yard changes of the ADU that was added, and was not reported to the department prior to this visit.

LPA Calderon reviewed (4) children records, all files had appropriate documentation in place. Infants in care had 15 min sleep log and LIC9227 Individual Infant Safe sleep plan if they were 0-12mths old.
LPA reviewed records for staff at 2:50pm Licensee Pediatric 1st aid expires 3/2026 and mandated reporter expires: 1/10/26 and all other staff assistant files had appropriate qualification to assistant at the day care.

(Pg 2)

NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025

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: VILLALTA AGUILAR FAMILY CHILD CARE	FACILITY NUMBER: 198400950
	VISIT DATE: 10/17/2025

NARRATIVE

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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.
Licensee 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 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. 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.
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 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.

Per California Code of Regulation Title 22, facility was given (2) deficiencies, see LIC809-D page. A Notice of Site visit was given and must be posted for 30 days. An exit interview was conducted with Licensee Doris Villalta Aguilar.

(Pg 3)

NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/17/2025 03:41 PM - It Cannot Be Edited

Created By: Ashley Calderon On 10/17/2025 at 03:18 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: VILLALTA AGUILAR FAMILY CHILD CARE	FACILITY NUMBER: 198400950
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/17/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416.2(a)(2)

Reporting Requirements

(a) The licensee shall report the following information the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm). (2) Any change in household composition including adults moving in or out of the home and anyone living in the home who reaches his or her 18th birthday. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on Licensee D.Villalta informed LPA Calderon an additional adult living that lives in the home; and is fingerprinted, LPA per record review from Guardian Roster observed individual is fingerprinted cleared, deficiency cited as change was not reported to the department when adult moved in back in 8/2024, the licensee did not comply with the section cited above in [1] out of [1] did not report change which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/24/2025
	Plan of Correction
1 2 3 4	Licensee will mail in Application LIC279 and 279 B Current children living in the home to Department mailing address by poc due date.

Type B

Section Cited

CCR

102416.3(a)

Alterations to Existing Building or Grounds

(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA discussed individuals residing in the home were noted and found fingerprinted cleared and Licensee informed LPA of changes of the home sketch, home added an ADU with the same address as above, deficiency cited as changes in the physical plant was not reported to the department, the licensee did not comply with the section cited above in [1] out of [1] Sketch change not reported which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/20/2025
	Plan of Correction
1 2 3 4	LPA during visit was given LIC999 Backyard sketch with ADU drawn, POC cleared during visit.

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: 10/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025

LIC809 (FAS) - (06/04)

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