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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364802729
Report Date: 06/18/2025
Date Signed: 06/18/2025 12:47:19 PM

Document Has Been Signed on 06/18/2025 12:47 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:GUZMAN FAMILY CHILD CAREFACILITY NUMBER:
364802729
ADMINISTRATOR/
DIRECTOR:		GUZMAN, GUADALUPEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 982-5857
CITY:UPLANDSTATE: CAZIP CODE:
91786
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
06/18/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:53 AM
MET WITH:Guadalupe GuzmanTIME VISIT/
INSPECTION COMPLETED:
01:05 PM
NARRATIVE
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On date and time listed above, Licensing Program Analyst (LPA) Chase Atherton arrived at the facility to continue an annual inspection that started on 6/16/2025. LPA was granted entry by Licensee, Guadalupe Guzman. LPA toured the facility, inside and out, reviewed records, and observed and/or discussed the following:
Days and hours of operation are Monday- Friday, 7:00am - 6:30pm
OFF-LIMIT AREAS INCLUDE: All bedrooms and living room. Garage is not to be used daily as a child care room. SEE LIC809D for deficiency cited.
The inspection consisted of reviews of the CARE tool domains. The inspection found the facility to be in compliance except as noted on the LIC809D. Deficiencies were cited this visit.
The facility is operating within the licensed capacity and appropriate ratios.
Licensee is present in the home and appropriate supervision is provided.
A working telephone is present. Cellphone and landline
Appropriate fire extinguisher is present. Smoke and carbon monoxide detectors are present and were tested by the Licensee during this inspection.
All hazardous items were not inaccessible for the entirety of this visit, which could pose a danger to children. SEE LIC809D for deficiency cited
Storage of poisons/toxins are locked.
Fireplace is properly screened: yes, metal screen. No stairs present.
Facility is clean, orderly and has adequate heating and ventilation.
Facility has safe and age-appropriate toys for both indoor and outdoor activities.
Outdoor play area is fenced.

Page 1/4 of LIC809
NAME OF LICENSING PROGRAM MANAGER: Ana Noble
NAME OF LICENSING PROGRAM ANALYST: Chase Atherton
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/18/2025
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 12
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)
Page: 2 of 12
Document Has Been Signed on 06/18/2025 12:47 PM - It Cannot Be Edited


Created By: Chase Atherton On 06/18/2025 at 09:58 AM
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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: GUZMAN FAMILY CHILD CARE
FACILITY NUMBER: 364802729

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102423(a)(2)
Personal Rights
(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in that the licensee used the garage as a child care room. During the visit dated 6/16/2025 LPA observed that for at least 2 hours the garage was being utilized as a childcare room. This is not safe or healthful as the fire clearance specifies that the garage is not to be used as a child care room. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/19/2025
Plan of Correction
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Facility will immediately cease using the garage as a child care room. Facility will submit a written statement (signed and dated) detailing their understanding that the garage is not to be used as a regular daycare room. An office conference will be scheduled to discuss compliance history further.
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.
Ana Noble
NAME OF LICENSING PROGRAM MANAGER:
Chase Atherton
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/18/2025


LIC809 (FAS) - (06/04)
Page: 3 of 12
Document Has Been Signed on 06/18/2025 12:47 PM - It Cannot Be Edited


Created By: Chase Atherton On 06/18/2025 at 09:58 AM
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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: GUZMAN FAMILY CHILD CARE
FACILITY NUMBER: 364802729

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that there were 23 knives, 1 pair of scissors, 3 wrenches, 2 lighters, and 2 screw drivers in drawers in the kitchen, accessible to children. At 8:53am for about 10 minutes, LPA observed the licensee had not yet put up the gate they use to keep the kitchen and the living room off limits, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/18/2025
Plan of Correction
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Facility put up the gate they use to keep the kitchen off limits during this visit, bringing the facility back into compliance.
Type B
Section Cited
HSC
1596.814(a)(1)(A)(i)
Pool Safety
(a) A licensed family daycare home operated at a private single-family dwelling with an in-ground swimming pool on the premises shall comply with all of the following requirements: (1) The swimming pool shall be equipped with, at minimum, the following drowning prevention safety features: (A) An enclosure, including, but not limited to, a fence, wall, or other barrier that isolates the swimming pool from access to the family daycare home and has all of the following characteristics: (i) An access gate that opens away from the swimming pool and is self-closing with a self-latching, key lockable device placed no lower than 60 inches above the ground.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in that although the gate is self-closing with a self-latching device, the device is not key lockable. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/16/2025
Plan of Correction
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Facility will submit proof (pictures) of the key lockable device installed on the gate to the pool to the Department by the POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ana Noble
NAME OF LICENSING PROGRAM MANAGER:
Chase Atherton
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/18/2025


LIC809 (FAS) - (06/04)
Page: 4 of 12
Document Has Been Signed on 06/18/2025 12:47 PM - It Cannot Be Edited


Created By: Chase Atherton On 06/18/2025 at 09:58 AM
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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: GUZMAN FAMILY CHILD CARE
FACILITY NUMBER: 364802729

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.814(a)(1)(A)(iv)
Pool Safety
(a) A licensed family daycare home operated at a private single-family dwelling with an in-ground swimming pool on the premises shall comply with all of the following requirements: (1) The swimming pool shall be equipped with, at minimum, the following drowning prevention safety features: (A) An enclosure, including, but not limited to, a fence, wall, or other barrier that isolates the swimming pool from access to the family daycare home and has all of the following characteristics: (iv) No gaps or voids that can allow the passage of a sphere with a diameter equal to or greater than four inches.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that the fencing for the pool has 2 locations where passage of a sphere with a diameter equal to or greater than four inches is possible by pushing on the fencing, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/18/2025
Plan of Correction
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Facility will submit proof of the repaired fence by taking a video of themselves pushing on the bottom of each fence post and the bottom of each fencing segment that spans between each fence post. Facility will submit this video to the department by the POC due date.
Type B
Section Cited
HSC
1596.814(a)(1)(B)
Pool Safety
(a) A licensed family daycare home operated at a private single-family dwelling with an in-ground swimming pool on the premises shall comply with all of the following requirements: (1) The swimming pool shall be equipped with, at minimum, the following drowning prevention safety features: (B) In addition to the characteristics described in subparagraph (A), at least one of the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in that they do not have one of the following: pool cover or pool alarm, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/16/2025
Plan of Correction
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Facility will submit proof (pictures) of either a pool cover in compliance with all regulations and written directives or a pool alarm in compliance with all regulations and written directives. Facility will also submit proof (pictures) of information and standards that these items meet. Both of the above items will be submitted to the Department by the POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ana Noble
NAME OF LICENSING PROGRAM MANAGER:
Chase Atherton
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/18/2025


LIC809 (FAS) - (06/04)
Page: 5 of 12
Document Has Been Signed on 06/18/2025 12:47 PM - It Cannot Be Edited


Created By: Chase Atherton On 06/18/2025 at 09:58 AM
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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: GUZMAN FAMILY CHILD CARE
FACILITY NUMBER: 364802729

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.814(a)(2)(A)
Pool Safety
(a) A licensed family daycare home operated at a private single-family dwelling with an in-ground swimming pool on the premises shall comply with all of the following requirements: (2) The licensee shall have the following safety equipment visible from the swimming pool and readily available for immediate use: (A) A life ring with a minimum exterior diameter of 17 inches and labeled as approved by the United States Coast Guard.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in that the facility does not have a life ring with a minimum exterior diameter of 17 inches and labeled as approved by the United States Coast Guard readily available, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/16/2025
Plan of Correction
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Facility will submit proof (pictures) of a life ring with a minimum exterior diameter of 17 inches and labeled as approved by the United States Coast Guard to the Department by the POC due date. These pictures will include a measuring device next to the life ring that can clearly show the exterior diameter.
Type B
Section Cited
HSC
1596.814(a)(2)(B)
Pool Safety
(a) A licensed family daycare home operated at a private single-family dwelling with an in-ground swimming pool on the premises shall comply with all of the following requirements: (2) The licensee shall have the following safety equipment visible from the swimming pool and readily available for immediate use: (B) A rescue pole with a body hook and a minimum fixed length of 12 feet.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that facility does not have a rescue pole with a body hook and a minimum fixed length of 12 feet readily available, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/16/2025
Plan of Correction
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Facility will submit proof (pictures) of a rescue pole with a body hook and a minimum fixed length of 12 feet to the Department by the POC due date. These pictures will include a measuring device next to the life ring that can clearly show the minimum fixed length.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ana Noble
NAME OF LICENSING PROGRAM MANAGER:
Chase Atherton
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/18/2025


LIC809 (FAS) - (06/04)
Page: 6 of 12
Document Has Been Signed on 06/18/2025 12:47 PM - It Cannot Be Edited


Created By: Chase Atherton On 06/18/2025 at 09:58 AM
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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: GUZMAN FAMILY CHILD CARE
FACILITY NUMBER: 364802729

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.814(a)(3)
Pool Safety
(a) A licensed family daycare home operated at a private single-family dwelling with an in-ground swimming pool on the premises shall comply with all of the following requirements: (3) A licensee shall perform a daily inspection of the drowning prevention safety features and safety equipment before opening the facility and maintain a log of the inspections to be provided to the department upon request.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on observation and interview, the licensee did not comply with the section cited above in that the licensee does not perform a daily inspection of drowning prevention safety features and does not maintain a log of inspections, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/18/2025
Plan of Correction
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Facility will submit proof (a copy) of a log that documents 2 days worth of daily inspections of safety equipment to the Department by the POC due date.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that Staff 1 (S1)'s and S2's mandated reporter training certificate has expired. S1's mandated reporter training certificate expired 4/2025 and S2's mandated reporter training certificate is not available to review, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/16/2025
Plan of Correction
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Facility will submit proof (a copy) of current mandated reporter training certificates for both S1 and S2 to the Department by the POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ana Noble
NAME OF LICENSING PROGRAM MANAGER:
Chase Atherton
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/18/2025


LIC809 (FAS) - (06/04)
Page: 7 of 12
Document Has Been Signed on 06/18/2025 12:47 PM - It Cannot Be Edited


Created By: Chase Atherton On 06/18/2025 at 09:58 AM
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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: GUZMAN FAMILY CHILD CARE
FACILITY NUMBER: 364802729

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that neither Staff 1 (S1) or S2 had current Pediatric CPR/First Aid. S1's Pediatric CPR/First Aid certificate expired 4/2025 and S2's CPR/First Aid certificate was not available to review, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/16/2025
Plan of Correction
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Facility will submit proof (a copy) of a current, ESMA approved, CPR/First Aid certificate for S1 to the department by the POC due date. Optionally, the facility will also submit proof (a copy) of a current, ESMA approved, CPR/First Aid certificate for S2 if they S2 is to be left alone with children, to the department by the POC due date.
Type B
Section Cited
CCR
102416.1(a)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that S2 did not have a file available to review. S2 is fingerprint cleared and associated to the facility, however there is no file present at the facility with the required paperwork for an assistant, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/16/2025
Plan of Correction
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3
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Facility will submit proof (copies) of LIC9052 Employee Rights, immunization records (containing proof of immunity to measles, pertussis, and flu), and tuberculosis clearance to the department by the POC due date. Additionally the facility will submit a photo copy of the front and back of S2's driver's licesnse to the department by the POC due date, if S2 is to transport children.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ana Noble
NAME OF LICENSING PROGRAM MANAGER:
Chase Atherton
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/18/2025


LIC809 (FAS) - (06/04)
Page: 8 of 12
Document Has Been Signed on 06/18/2025 12:47 PM - It Cannot Be Edited


Created By: Chase Atherton On 06/18/2025 at 09:58 AM
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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: GUZMAN FAMILY CHILD CARE
FACILITY NUMBER: 364802729

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.3(a)(1)
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: (1) Conversion of a garage (either attached or detached) into a "child care" room.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
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3
4
Based on observation and interview, the licensee did not comply with the section cited above in that the garage is being used as a child care room, the Department was not notified of this, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/16/2025
Plan of Correction
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Facility will submit proof (copies) of an inspection report when it is required by the local building inspector for using the garage as a child care room. Additionally the facility will submit a written statement (signed and dated) that describes their understanding of CCR section 102416.3(a)(1). Both items above will be submitted to the Department by the POC due date.
Section Cited
Deficient Practice Statement
1
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POC Due Date:
Plan of Correction
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4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ana Noble
NAME OF LICENSING PROGRAM MANAGER:
Chase Atherton
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/18/2025


LIC809 (FAS) - (06/04)
Page: 9 of 12
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: GUZMAN FAMILY CHILD CARE
FACILITY NUMBER: 364802729
VISIT DATE: 06/18/2025
NARRATIVE
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Verification of control of property on file.
Property owner/landlord notification and consent on file.
License, Emergency Disaster Plan (LIC610) and Earthquake Preparedness Checklist (LIC9148) Parent’s Rights Poster (PUB393), Personal Rights, Child Car Seat Law are posted.
- Pediatric CPR and First Aid Card IS EXPIRED and expired on: 4/2025. SEE LIC809D for deficiency cited
- Health & Safety Certificate - completed on file.
- Mandated reporter: Child Care Expires: Not RENEWED. SEE LIC809D for deficiency cited.
- Fire clearance: 7/1/2013
- Documentation of fire & earthquake drills completed. Last drill: 3/12/2025
- Children’s records are complete.
- Employee records are NOT complete. SEE LIC809D for deficiency cited
- No guns or weapons present as stated by the Licensee. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 regulations.

There are bodies of water during this visit. Licensee understands all bodies of water must be properly covered or fenced per Title 22 regulations. The Department must be notified before and after installation of the above types of bodies of water. SEE multiple LIC809Ds for deficiencies cited.

Additionally, the following was reviewed with Licensee.
- AB 1207 – Mandated Child Abuse Reporting: Child Day Care Personnel Training, beginning January 1, 2018 – Requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years.

AB2960 – Childcare and development services, online portal – Effective June 20, 2022 - This bill requires the State Superintendent of Public Instruction (SSPI), within the California Department of Education (CDE), to develop and post on CDE's website a comprehensive child care and development services online portal for families and providers by June 30, 2022.
- Effective January 1, 2017 – Children under 2 years of age shall ride in a rear-facing car seat unless the child weighs 40 or more pounds OR is 40 or more inches tall. For additional information regarding car seat laws see www.chp.ca.gov

Page 2/4 of LIC809.
NAME OF LICENSING PROGRAM MANAGER: Ana Noble
NAME OF LICENSING PROGRAM ANALYST: Chase Atherton
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025
LIC809 (FAS) - (06/04)
Page: 10 of 12
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: GUZMAN FAMILY CHILD CARE
FACILITY NUMBER: 364802729
VISIT DATE: 06/18/2025
NARRATIVE
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-Licensee provided the Unusual Incident Reporting email: UnusualIncidentReportsDO09@dss.ca.gov
-The Duty Officer is available to answer questions Mon. – Fri. at 1-844-LET-US-NO (1-844-538-8766)

-Access to forms & Regulations for Family Child Care Homes online at www.ccld.ca.gov
-There is a responsibility to know the regulations for anyone providing care.
-Failure to meet the posting requirements shall result in an immediate civil penalty.

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

MyChildCarePlan.org – Centers and Family Child Care Homes Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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 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.


Page 3/4 of LIC809.
NAME OF LICENSING PROGRAM MANAGER: Ana Noble
NAME OF LICENSING PROGRAM ANALYST: Chase Atherton
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025
LIC809 (FAS) - (06/04)
Page: 11 of 12
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: GUZMAN FAMILY CHILD CARE
FACILITY NUMBER: 364802729
VISIT DATE: 06/18/2025
NARRATIVE
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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page 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 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.

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.

LPA informed Licensee Guadalupe Guzman that this report dated 6/18/2025 document(s) 1 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA informed the Licensee Guadalupe Guzman to provide a copy of this licensing report dated 6/18/2025 that documents any Type A citation(s) to parents of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

During the exit interview, the Licensee Guadalupe Guzman, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
Exit interview conducted and report was reviewed with the licensee Guadalupe Guzman.
A notice of site visit was given and must remain posted for 30 days.

Page 4/4 of LIC809. However, report continues on LIC809D. There are seven LIC809D pages attached to this report that detail deficiencies cited.

NAME OF LICENSING PROGRAM MANAGER: Ana Noble
NAME OF LICENSING PROGRAM ANALYST: Chase Atherton
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025
LIC809 (FAS) - (06/04)
Page: 12 of 12