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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192001144
Report Date: 02/23/2026
Date Signed: 02/23/2026 02:46:27 PM

Document Has Been Signed on 02/23/2026 02:46 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:PLASENCIA FAMILY CHILD CAREFACILITY NUMBER:
192001144
ADMINISTRATOR/
DIRECTOR:		PLASENCIA, DOLORESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 353-0702
CITY:MONROVIASTATE: CAZIP CODE:
91016
CAPACITY: 14TOTAL ENROLLED CHILDREN: 6CENSUS: 3DATE:
02/23/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:50 PM
MET WITH:Licensee Dolores PlasenciaTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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At 12:50pm, Licensing Program Analyst (LPA) Stephanie Li conducted an unannounced annual inspection to the above facility. A risk assessment was conducted upon entry. LPA met with Licensee Dolores Plasencia, who led LPA on a tour of the facility. There are currently 6 children enrolled. There was 1 adult and 2 children present upon arrival. Facility capacity is in compliance for a Large Family Child Care Home. Hours of operation are Monday-Friday, currently 6:00am-5:30pm.

This is a one story home, which consists of 3 bedrooms, 2 bathroom, kitchen, living room, dining room, family room (day care area), garage, back yard and front yard. On limits to children are family room (daycare area), 1 bathroom, and back yard. Per licensee, areas off limits to children and parents include: 3 bedroom, 1 bathroom, garage, kitchen, and dining room. The LPA toured all areas used by children during this visit.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There is central AC and heat. There is telephone service via cell phone that stays at the facility during operation hours.


LPA observed that the following required postings were up: Facility License, Publication (PUB) 394- Notification of Parent Rights and LIC 610- Facility Disaster Plan. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Last drill was conducted in 4/14/2025. Per licensee, she has not completed a new disaster drill. A technical violation is being issued. Licensee stated she will make a new log for 2026 and conduct a disaster drill.

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NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Stephanie Li
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 02/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2026
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 5
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: PLASENCIA FAMILY CHILD CARE
FACILITY NUMBER: 192001144
VISIT DATE: 02/23/2026
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There are toys, equipment and learning materials available for children. There are cots available for each child to nap. First aid kit is available. Drinking water is available through bottled water. Licensee provides food breakfast, lunch,and pm snack.

LPA observed the required fire extinguisher 2A 10BC, last serviced 2/2025. Per State Fire Marshall standards, fire extinguishers shall be serviced or purchased annually. Licensee is aware that fire extinguisher needs to be serviced or purchased before the month is over. Smoke and carbon monoxide detector were tested and operable. A fireplace was observed to be missing a firescreen. Per licensee, work was done on the fireplace and workers broke fire screen when removing it. Licensee stated she will have fire screening placed in. A technical violation is being issued.

Cleaning compounds were observed under the kitchen sink, sink did not have a child lock. Licensee placed cabinet child lock during visit making cleaning compounds in assessable. LPA observed a gate in family room restricting children from having access to kitchen and dining room. LPA observed drawer storing knives has a child safety lock that was broken. Per licensee, she will have the drawer safety lock replaced. Children present at the time did not have access to the kitchen because of the gate placed in the family room. LPA reminded Licensee that are hazardous items like cleaning compounds, sharp items, knives, and tools must be made in assessable to children while in care. Licensing staff reminded licensee smoking is not allowed in a family child care home. The restroom that children use was observed to be safe and sanitary. LPA observed 2 open bedroom doors in the hallway near the bathroom. Per licensee, 2 bedrooms are empty and not used by adults or children. LPA checked in the rooms and nothing hazardous was observed. LPA reminded licensee that off limits room must be made off limits. LPA also observed the garage door near the front door was unlocked and advised to lock the door so children can not enter. Per licensee, she is going to have parents drop off from the side gate to enter the back door into the family room where daycare is held.

LPA observed the back yard area. The outdoor play area was observed to be fenced. There are age appropriate materials for preschool and school age children to use while outdoors. LPA observed some tools on top of an adult table. Hazardous items were moved to higher shelf during visit. Licensee has 4 smaller breed dogs that reside in the off limits hallway during care hours. Dogs also use the backyard when children are napping. LPA advised to clean and remove all droppings before returning the children to outdoor play.



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NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Stephanie Li
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2026
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: PLASENCIA FAMILY CHILD CARE
FACILITY NUMBER: 192001144
VISIT DATE: 02/23/2026
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Adult and children’s records were reviewed. The licensee has completed Pediatric First Aid and CPR. Exp 3/16/2026. Licensee has Mandated Reporter AB 1207 Child Care Training certificates that expires in 3/9/2027. One child’s file is missing signed liability waiver form (lic282) . A technical violation is being issued.
Incidental Medical Services (IMS) is not currently being provided at this time. For IMS information see PIN 22-02- CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

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



LPA advised the licensee to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov.
LPA showed licensee how to change the language to Cantonese on the CCLD website. Language selection is on the top right white box of the web page.

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/process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.


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NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Stephanie Li
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2026
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: PLASENCIA FAMILY CHILD CARE
FACILITY NUMBER: 192001144
VISIT DATE: 02/23/2026
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Based on LPA observation and interview, technical violations are being issued. Technical violation needs to be cleared to protect the health and safety of children in care.

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

Exit interview conducted, report reviewed was reviewed with Licensee Dolores Placensia.

NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Stephanie Li
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2026
LIC809 (FAS) - (06/04)
Page: 5 of 5