191501110-12-3-2025-33-CC-DORZ-DNZVPP-20251203153703

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191501110
Report Date: 12/03/2025
Date Signed: 12/03/2025 03:37:32 PM

Document Has Been Signed on 12/03/2025 03:37 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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	RIOS & GUTIERREZ FAMILY DAY CARE		FACILITY NUMBER:	191501110
ADMINISTRATOR/ DIRECTOR:	RIOS,S & GUTIERREZ, E		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(909) 593-0308
CITY:	LA VERNE	STATE: CA	ZIP CODE:	91750
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 9	CENSUS: 0	DATE:	12/03/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:36 PM
MET WITH:	Stella Rios, Licensee		TIME VISIT/ INSPECTION COMPLETED:	03:55 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	On 12/03/25 at 12:35pm, Licensing Program Analyst (LPA) Diana Ortiz conducted an unannounced Annual random inspection to the above facility. Upon arrival, LPA disclosed the purpose of the inspection and met with Licensee, Stella Rios, who guided the LPA on a tour of the facility. Licensee’s Assistant was also present during todays visit. Adults in the home were discussed, and all have criminal record clearance. There were zero (0) children present during today’s inspection. Licensee states that there are currently nine (9) children enrolled. Per licensee, the facility’s hours of operation are Monday through Friday from 6am to 6pm. Emergency Disaster Plan, License, and Parents’ Rights were posted at the time of inspection. Facility capacity is in compliance for a large Family Child Care Home. LIC 126 was provided. This is a one-story home which consists of 3 bedrooms, 2 bathrooms, kitchen, dining room, living room, front yard and backyard (fenced). The children use the living room, dining room, kitchen, and one bathroom. Per licensee, areas off limits to children and parents include: all bedrooms, hallway, one-bathroom, front yard, and back yard. All areas identified on the facility sketch were inspected. At 12:50pm, LPA was led on a tour of the facility by the licensee. Upon entry into the home, LPA reviewed the living room, which is being used as the main childcare area. The dining area is used for snacks and for children to do their homework. Licensee is currently caring for school age children. The kitchen was observed and was free of any hazards. LPA observed the kitchen knives are kept in a high cupboard which make them inaccessible to children. The tour continued to the back of the home where the bathroom for children in care was. Page 1 of 3

NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Diana Ortiz
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: RIOS & GUTIERREZ FAMILY DAY CARE	FACILITY NUMBER: 191501110
	VISIT DATE: 12/03/2025

NARRATIVE

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The children have to enter the hallway to access the restroom and per licensee, they guide the children to the restroom. Detergents, cleaning compounds, medications, and other items which could pose a danger are kept in the laundry room locked in a storage room which makes them inaccessible to children. LPA advised that any poisons should be locked under key or combination lock. Licensee does not have firearms in the home.

LPA observed the following required posted documentation in the main entry way of the facility: Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPAs reviewed facility records for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan.

LPA observed the back yard area. The outdoor play area was observed to be fenced. Per Licensee, at this time, children are not using the backyard due to some maintenance work done on the house. The licensee is observed to be operating within the license capacity limitations.

LPA observed two (2) dogs during today’s visit. Per Licensee, the dogs are kept in one of the bedrooms during Daycare hours making them inaccessible to children.

Per licensee, they provide breakfast, lunch, PM snack and dinner for children in care. Sick/isolation area is in the living room/daycare room. Per licensee, the sofa is used for an ill child until an authorized representative comes to pick up child.

LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, and/or any other items that fall into these categories are not permitted in a family childcare facility.

Licensee file was reviewed for the following: LIC 508- Criminal Record Statement, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse. Pediatric First Aid and CPR certification expires on 03/2026 for licensee and licensees assistant. Mandated Reporter Training for licensee and licensees assistant was on file during todays visit and expired on 11/2025. www.mandatedreporterca.com

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NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Diana Ortiz
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2025

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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: RIOS & GUTIERREZ FAMILY DAY CARE	FACILITY NUMBER: 191501110
	VISIT DATE: 12/03/2025

NARRATIVE

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LPA discussed with licensee the requirement to have documentation of the purchase/inspection of the fire extinguisher, for review. LPA observed that the 2A10BC fire extinguisher was fully charged and present. Licensee states they will get a new one and keep the receipt on it. Smoke and carbon monoxide detectors were tested and were operable on this day.

All homes shall conduct fire and disaster drills at least once every six months and document the date and time of each drill. Per Licensee, last fire drill conducted was on 09/01/2025.

The home is observed to be clean and orderly. There are first aid supplies available. There are age-appropriate toys available for children.

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

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NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Diana Ortiz
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/03/2025 03:37 PM - It Cannot Be Edited

Created By: Diana Ortiz On 12/03/2025 at 02:03 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: RIOS & GUTIERREZ FAMILY DAY CARE	FACILITY NUMBER: 191501110
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/03/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above in completing Mandated Reporter training which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/17/2025
	Plan of Correction
1 2 3 4	Per Licensee and Licensees assistant, they will complete and provide proof of mandated reporter training completion to LPA by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 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.

	Brandi VanOosten
NAME OF LICENSING PROGRAM MANAGER:

	Diana Ortiz
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2025

LIC809 (FAS) - (06/04)

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