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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198401123
Report Date: 01/29/2026
Date Signed: 01/29/2026 12:57:30 PM

Document Has Been Signed on 01/29/2026 12:57 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:ARROYO FAMILY CHILD CAREFACILITY NUMBER:
198401123
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
01/29/2026
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Mirna ArroyoTIME VISIT/
INSPECTION COMPLETED:
12:35 PM
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On 1/29/2026 at 9:45 AM Licensing Program Analyst (LPA) Claudia Kam conducted an announced pre-licensing inspection to the above-mentioned address. LPA disclosed the purpose of the inspection and was granted entry to the facility by the applicant.

Entrance Checklist was provided to the licensee. The licensee is requesting a large family childcare home license. Per licensee, operation hours will be Monday through Friday, 6:00 AM to 6:00 PM. Applicant states that they will care for children ages 0-13 years old and up. Licensee guided LPA on a tour of the home. LPA observed 2 total adults (both licensee's) present during the inspection. All adults living in the home have been live scanned, cleared and associated to the home. Individuals residing in the home have been noted and discussed. 4 children (preschool age) were observed to be in care during inspection.

This is a two-story home that consists of 2 bedrooms 2 bath, dining room, living room, kitchen, and patio. The off-limit areas of the home are the second story consisting of 2 bedrooms, 1 bathroom, kitchen, and dining room. Fire clearance discussed as second story has been disapproved. Licensee has been granted fire clearance for downstairs only. Main care area is located downstairs in the open concept living room and outdoor patio. LPA observed a large play rug, dramatic play area, bookcases with books, cubbies with toys, a large table with child size chairs, white board, and mounted television. Cubbies are located on the rear wall with a large drawer for each child in the main care area. There are storage cabinets for supplies such as diapers and paper goods along the right wall. A sink and cabinets are located at the left of the room with cleaning supplies stored with safety lock on the bottom cabinets. Required postings observed at time of inspection, licensing board discussed. The licensee's has completed the required Health and Safety Training, Nutrition, and Lead Training, Mandated Reporter Training and Pediatric First Aid and CPR.


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NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Claudia Kam
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2026
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: ARROYO FAMILY CHILD CARE
FACILITY NUMBER: 198401123
VISIT DATE: 01/29/2026
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Applicant has proof of required immunization records. There are no assistants currently employed. There are first aid supplies available upstairs in prior area which will be moved downstairs in the newly approved space. LPA observed that the Applicant has a 2A10 BC fire extinguisher in the home, no proof of purchase available. Smoke detector/ Carbon Monoxide was tested and was operable at time of inspection. Cleaning supplies, chemicals, solvents, and medications are stored out of reach and inaccessible to children; and inaccessible to children by safety lock on storage cabinet at the rear of the living room next to the refrigerator. Per licensee there are no poisons at the facility. The licensee was advised that any poisons must be locked, not just inaccessible. Licensee states there are no guns in the home. LPA did not observe any of the bodies of water, hazardous items, or firearms at time of inspection. LPA observe 2 small turtles in the home in a turtle habitat during today's visit on the large child table. All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. All areas identified on the facility sketch as accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. The applicant understands that licensing staff may have access to off-limit areas during inspection visit if necessary.

The bathroom located at the front of the living room was observed to be clean with an operable sink, faucet and toilet. There is a two in one washer dryer and shower in the bathroom. Shower is not in use and used for storage. No hazards observed at time of inspection. Licensee has reported that food will be prepared in the off limits kitchen upstairs. Meal area will be in the downstairs living room at the large child size table. Licensee's kitchen has been observed to be free of hazards and refrigerator has been observed to be in good condition at time of inspection. Food was observed to be properly stored and refrigerated at time of inspection.

The outdoor play area is located on the patio outside of the living room. LPA has observed perimeter fencing and play area to be equipped with a play house, tables, swing set, a large shade sail over play area, and ride on toys. Patio has concrete flooring and artificial grass. Off limits areas are separated by a metal fence in the outdoor play area. There are 3 small Pomeranian dogs that are kept in kennels during care hours in the off limits areas. LPA observed the patio area to be free of loose and sharp parts.

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NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Claudia Kam
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: ARROYO FAMILY CHILD CARE
FACILITY NUMBER: 198401123
VISIT DATE: 01/29/2026
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LPA observed operable telephone service via a cell phone. Applicant was advised the cell phone must be kept at the facility during operation hours.

The following were discussed with the Licensee:

Because the licensee rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC 9151) that the licensee confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

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-andresources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for and removing any 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 2202-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) 5140383 (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/.


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NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Claudia Kam
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: ARROYO FAMILY CHILD CARE
FACILITY NUMBER: 198401123
VISIT DATE: 01/29/2026
NARRATIVE
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LPA reviewed with applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

On this date, 1/29/2026, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.


Exit interview conducted and report was reviewed with the licensee Mirna Arroyo.

Prior to approval the following items will need to be corrected:
- current fire extinguisher


Licensee has stated that corrections will be completed by 2/15/2026.

A large family childcare license may be granted upon Licensing Program Manager (LPM) Approval for requested large facility license. Once licensed, the applicant is required to comply with the terms and limitations stated on the license.

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



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NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Claudia Kam
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: ARROYO FAMILY CHILD CARE
FACILITY NUMBER: 198401123
VISIT DATE: 01/29/2026
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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.


A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Mirna Arroyo.


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NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Claudia Kam
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026
LIC809 (FAS) - (06/04)
Page: 6 of 6