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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304314825
Report Date: 07/15/2026
Date Signed: 07/15/2026 12:43:27 PM

Document Has Been Signed on 07/15/2026 12:43 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:PEREZ, GLADYS MARISSAFACILITY NUMBER:
304314825
ADMINISTRATOR/
DIRECTOR:		PEREZ, GLADYS MARISSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 496-2111
CITY:SANTA ANASTATE: CAZIP CODE:
92704
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
07/15/2026
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:16 AM
MET WITH:Applicant, Gladys MarissaTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On 07/15/2026, Licensing Program Analyst (LPA), Deschampe conducted an announced, in-person pre-licensing inspection for the purpose of relocating from facility number 304314151, Large Family Child Care Home (FCCH), to this location. LPA was allowed entry to the FCCH by the applicant, Gladys Marissa Perez at 9:16AM. LPA explained the purpose of the visit and was guided on a tour of the home. The applicant is requesting a Large Family Child Care Home license. Per the applicant, operation hours will be Monday through Saturday. Care and supervision will be provided to children 0 months through 14 years of age. For the purposes of licensing, an infant is defined as any child 0 to 24 months of age.

A review of the Facility Personnel Report Summary indicates 2 adults, including the applicant and 2 minors, live in the home. The adult resident received caregiver background check clearances or exemptions as required by the Department. The applicant stated that they are not registered with any resource Foster Care Agency and that they do not hold a resource foster parent license. The applicant was reminded to notify the licensing office of any changes. Criminal Background Clearance: Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.
NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Susan Deschampe
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/15/2026
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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: PEREZ, GLADYS MARISSA
FACILITY NUMBER: 304314825
VISIT DATE: 07/15/2026
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Inspection Authority: All adults living and working in the home shall be made aware of the Department’s right to inspection authority, which includes but is not limited to the right to enter the home when children are
being cared for, interview children and adults, and review documentation.
Facility Sketch (LIC999): All areas on the LIC999 were inspected, including but not limited to, off-limits areas. The facility is a 2 story home, 4 bedrooms, 2.5 bathrooms, living room, dining area, kitchen, staircase, family room/playroom, frontyard, backyard, outdoor patio, and 3 car garage.
Based on the LIC999 submitted, areas off-limits to children and parents/authorized representatives are as follows: The applicant designated the 4 bedrooms, 2 bathrooms, living room, dining area, kitchen, staircase, garage/studio, portion of the backyard, pool, and garage as off-limits. The applicant has child safety locks for all door handles, drawers, and cabinets. The garage/studio may be occupied by a family member who will not provide child care and who will only be present during non-operation hours. The home has a fireplace in the playroom, that is blocked with a fireplace screen and heavy furniture as an additional safety measure. The applicant understands that licensing staff may have access to off-limits areas during inspection visits, if necessary.
Based on the LIC999 submitted, designated areas for child care activities are as follows: The applicant designated the family room/playroom, connected 0.5 bathroom, outdoor patio as child care areas. Children will be napping in the play room, in either a play yard or cots. The entrance for the child care is through the side gate.
Areas that will be used by children in care were inspected for safety, comfort, cleanliness, telephone service (cell phone), ventilation, and heating. The children’s bathroom was observed to be safe. The applicant has safe toys, play equipment, and materials. The applicant was informed of the following: No smoking, No Johnny Jumpers, No saucer chairs, No bouncer chairs: Any other items that fall into that category are prohibited in the facility.
The applicant will be providing all food/meals, snacks/fruits, milk, and water, however, families may provide their own meals and drinks/formula/breast milk for children in care. The applicant was informed that when children bring food from home, the children’s names shall be labeled on their containers and refrigerated/stored properly. The applicant stated they will be accepting children in diapers and children who are toilet trained. Diapers and wipes will be provided by families with the child’s name on each item but,
NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Susan Deschampe
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026
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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: PEREZ, GLADYS MARISSA
FACILITY NUMBER: 304314825
VISIT DATE: 07/15/2026
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applicant will have diapers and wipes on hand, if necessary. Diaper changing area will be on a diaper changing table in the play room. Storage of diapers and wipes are in the cabinet of the diaper changing table. Personal belongings are kept in their personal/individual bags, brought daily and stored in individual cubbies. A first aid kit is available and stored in the kitchen.

Detergents, sharp objects, and hazardous items that can pose a danger to children are inaccessible in areas designated for children. LPA observed Lysol and bleach wipes in an area accessible to children, applicant to relocate these items. The applicant stated that there are no poisons on the premises. Firearm on the premises was observed to be stored according to California Code of Regulations (CCR) 102417(g)(4) Operation of a Family Child Care Home. The pressure gauge on the 2A-10BC fire extinguisher indicates fully charged (stored in the play room). The fire extinguisher must be serviced annually or as often as necessary. Smoke detector and carbon monoxide detector were tested and operable (in dining area and play room). Smoke and carbon monoxide detectors should be checked regularly and batteries replaced, as needed.



OUTDOOR PLAY AREA: Applicant stated the outdoor play activities will be conducted in the outdoor patio. The outdoor patio has a BBQ/Grill area with a smoker and grill to prevent access. Applicant to make the BBQ/Grill area inaccessible by alternate means.
There is a fenced pool, with a self-closing, self-latching gate that swings away from the pool. Applicant and child care staff can swim. Children will not be taken to the pool during operation hours. The fence is at least 5 feet in height and in good repair and completely surrounds the pool. The fence is designed and installed so children could not remove any portion of it. No window or door, from the designated child care areas, provides direct access to the pool. The opening between railing does not exceed 4 inches, and the bottom of the fence is no more than 4 inches from the ground on a hard surface. Fence is of sufficient strength to withstand the impact of toys (including weight of a dog). A life ring with a minimum exterior diameter of 17 inches with a United States Coast Guard approval label, was observed. Applicant agrees that the fencing will remain in place whenever licensed care is provided, and so long as the mesh fence makes the swimming pool inaccessible to children as determined by licensing staff. On the side away from the body of water, a protrusion was observed, (pony wall approximately 3 feet 7 inches next to the fence/fence gate to the pool, picture taken), which renders the barrier easily climbable by children. An adjustable rescue pole of 14 feet 5 inches was observed. Applicant to purchase a fixed length pole with a body hook, at least 12 feet in length.
NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Susan Deschampe
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026
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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: PEREZ, GLADYS MARISSA
FACILITY NUMBER: 304314825
VISIT DATE: 07/15/2026
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HSC 1597.622: 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. The applicant has submitted proof of immunization.

HSC 1596.7995: Beginning January 1, 2018, all licensed providers, applicants, directors, and employees must complete training as specified on mandated reporter duties. Training is available at www.mandatedreporterca.com. The applicant has a current Mandated Reporter certificate.
The applicant understands she must be present in the facility and must ensure children in care are always supervised. Applicant may transport children in her own vehicle. Children are not to be left alone in parked
vehicles. When the applicant is temporarily absent from the facility, arrangements must be made for a qualified substitute adult to care and supervise children while absent. The substitute adult must have the required criminal record clearance, child abuse index clearances, immunization, Pediatric CPR/First Aid, and mandated reporter training. LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian. CCLD website www.ccld.ca.gov was provided to applicant to access regulations, updates, and licensing forms.
Reporting Requirements CCR Section 102416.2 (copy given to applicant):
1. Changes should be reported to the Department as soon as they occur, such as construction, remodeling, telephone number changes, and/or moving out from your home.

2. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. The LPA advised the applicant on how to access forms, regulations, and quarterly updates on the Child Care Licensing website at: www.cdss.ca.gov/inforesources/community-care-licensing. LPA reviewed and issued the LIC311D “Forms/Records to Keep in Your Family Child Care Home” and provided the forms below.

Note: Children and Staff records must be kept and updated as necessary and must be available for review by the Department.



CHILDREN FORMS/RECORDS - Children’s files must contain the following completed documents and information: Identification and Emergency Information (LIC 700), Consent for Emergency Medical Treatment
NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Susan Deschampe
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026
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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: PEREZ, GLADYS MARISSA
FACILITY NUMBER: 304314825
VISIT DATE: 07/15/2026
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(LIC 627), Affidavit Regarding Liability Insurance (LIC 282), Parent Notification Additional Children in Care (LIC 9150), Notification of Parent’s Rights (LIC 995A), Caregiver Background Check Process (LIC 995E), California School Immunization Record (CDPH 286), Individual Infant Sleeping Plan (LIC 9227), Risk and Effects of Lead Poisoning (PUB 515), Family Child Care Consumer Awareness Information (LIC 9212), Blood Glucose Testing Consent/Verification (LIC 9222), Nebulizer Care Consent/Verification (LIC 9166), Acknowledgment of Receipt of Licensing Reports (LIC 9224).
FACILITY FORMS/RECORDS - Facility files must contain the following documents/information:
Emergency Disaster Plan (LIC 610A), Earthquake Preparedness Checklist (LIC 9148), Unusual Incident/Injury Report (LIC 624B), Child Care Facility Roster (LIC 9040), Property Owner/Landlord Notification (LIC 9149), Property Owner/Landlord Consent (LIC 9149), Entrance Checklist – Family Child Care Homes (LIC 126), Forms/Records to Keep In Your Family Child Care Home (LIC 311D), Safe Sleep Flyer-What Does A Safe Sleep Environment Look Like?, Never Ever Shake A Baby Brochure.
STAFF FORMS/RECORDS - Facility files must contain the following documents/information:
Personnel Records as specified in Title 22 Regulations 102416.1, Notice of Employee Rights (LIC 9052), Statement Acknowledging Requirement to Report Suspected Child Abuse (LIC 9108) Copy of Pediatric Cardiopulmonary Resuscitation & Pediatric First Aid (CPR & First Aid Certification), Proof of pertussis, measles, and Tuberculosis (TB) vaccines, Proof of influenza vaccine (or documentation of exemption), Proof of Mandated Reporter Training certificate, Copy of Criminal Background Clearance Transfer Request (LIC 9182), Copy of Criminal Record Exemption Transfer Request (LIC 9188). A facility record review indicates the applicant completed the required Health and Safety Training with Nutrition and Lead Poisoning components. Per the applicant, there are no dual licenses at this address. The applicant’s email address was confirmed during this inspection. The applicant was advised that the email address may be public information.
Information to be posted in FCCH – You are required by law to post the following:
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. Facility License (LIC 203), Notification of Parent’s Rights Poster (PUB 394), Earthquake Preparedness Checklist (LIC 9148), Emergency Disaster Plan (LIC 610A) California Car Seat Law (PUB 269). A Notice of Site Visit (LIC 9213) must be posted for 30 days after each site inspection by a Licensing Representative. Any Licensing Report documenting a Type “A” deficiency must be posted for 30 days during the hours that children are in care. Any Licensing Report or other document verifying compliance
NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Susan Deschampe
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026
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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: PEREZ, GLADYS MARISSA
FACILITY NUMBER: 304314825
VISIT DATE: 07/15/2026
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or non-compliance with the Department’s order to correct a Type “A” deficiency must be posted for 30 days during the hours that children are in care.


Other information and forms provided:
CCR Operation of a Family Child Care Home
CCR Reporting Requirements
The following was discussed with the applicant: 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.
Infant safe sleep: LPA discussed the safe sleep regulations with applicant 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 applicant 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. The following electronic links were also provided:
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
Spanish: https//www.cdph.ca.gov/programs/SIDS/Documents/ChildCareProvSleepSPAN2011.pdf
AAP:https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.asp
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternativeSafe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials
LPA reviewed with applicant the following safe sleep best practices:
· Always place infants on their backs for sleeping
· Use only a tight-fitting sheet on the crib or play yard mattress
· Do not hang any items from the crib or above the crib
· Keep all items, including blankets, out of the crib or play yard
NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Susan Deschampe
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026
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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: PEREZ, GLADYS MARISSA
FACILITY NUMBER: 304314825
VISIT DATE: 07/15/2026
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· Pacifiers may be used if they do not have items attached to them
· Infants should not be swaddled or have any items covering them while sleeping
· The temperature of the room should be comfortable enough for an adult to wear a T-shirt and not be too hot or too cold.
Megan’s Law: On this date, 07/15/2026, 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

Child Advocacy Program: The Child Advocacy Program was discussed with the applicant. The applicant was advised to register for the program to receive quarterly reports and other information in a timely manner. To register email ChildCareAdvocatesProgram@dss.ca.gov. Technical Support Program (TSP) discussed.



MyChildCarePlan.org: Applicant was informed of the MyChildCarePlan.org site, 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.

CCLD Important Information: Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.

To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.



Once licensed, the applicant is required to adhere to the terms and limitations stated on the license. A copy of this report and all other licensing reports must be made available to the public for 3 years.
The applicant provided proof of control of property.
NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Susan Deschampe
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026
LIC809 (FAS) - (06/04)
Page: 8 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: PEREZ, GLADYS MARISSA
FACILITY NUMBER: 304314825
VISIT DATE: 07/15/2026
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Each FCCH must conduct fire drills and disaster drills at least once every six months (applicant completes drills monthly). The licensee must document the date and time of each drill. This documentation must be kept at the facility for review by the Department.
Annual fees must be paid by the due date, or a late fee shall be assessed and/or the license may be terminated.
Applicant must post each facility license number in all advertisements, publications, or announcements with the intent to attract clients.

The Large Family Child Care Home was not in compliance with Title 22 Regulations at the time of inspection.
The applicant is required to submit the following correction to the licensing office by the due date of 08/12/2026.

1. Applicant to make pool inaccessible.
2. Applicant to purchase a fixed length pole with a body hook, at least 12 feet in length.
3. Make outdoor patio/BBQ/Grill area inaccessible to children.
4. Lysol, bleach wipes, etc. to be placed out of reach of all children.

In the event additional requirements are needed, the applicant will be notified. A license will be issued once all requirements are met and upon final review by management. Exit interview conducted and report was reviewed with the applicant, Gladys Marissa Perez.

End of report
NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Susan Deschampe
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026
LIC809 (FAS) - (06/04)
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