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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195700291
Report Date: 05/07/2026
Date Signed: 05/07/2026 11:24:02 AM

Document Has Been Signed on 05/07/2026 11:24 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:NEPOMUCENO FAMILY CHILD CAREFACILITY NUMBER:
195700291
ADMINISTRATOR/
DIRECTOR:		EDITH & ROSA NEPOMUCENOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 485-9803
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY: 14TOTAL ENROLLED CHILDREN: 16CENSUS: 11DATE:
05/07/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Licensee, Rosa NepomucenoTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
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On May 07, 2026, at approximately 9:00am, Licensing Program Analyst (LPA) Melissa Zaragoza conducted a unannounced, case management visit to Nepomuceno Family Child Care Home. LPA Zaragoza is conducting a visit regarding an Unusual Incident Report (UIR) that occurred on April 24, 2026. LPA met with the licensee, Rosa Nepomuceno, and explained the purpose of the visit. Present during LPA's visit included 1 staff assistant and 11 children present (8 preschool and 3 infants). Facility is operating within capacity limits and ratio during LPA's visit. Teaching staff present have criminal record clearance on file. Childcare hours of operation are Monday through Friday from 6:00am to 6:00pm.

On April 24, 2026, Child (C1) was stepping on wooden tree stumps with their friends, when they turned to look at a friend. While C1 looked at their friend, they lost balance, missed a step, and fell, causing an open wound on the top, left side of their eyebrow.

Licensee immediately took C1 to the bathroom sink and cleaned wound with a tissue and water. Per licensee, C1 got scared from the blood on their face. Licensee called C1s mother, while the assistant called the police. Shortly after the Paramedics arrived to the Family Child Care Home and observed C1. Per licensee, paramedics spoke with C1s mother and informed them C1 was fine, playing with Legos but, they will need stitches. Paramedics informed C1s mother, they could give C1 a ride to the emergency room or they could pick up C1 from day care and take them to the urgent care. Per licensee, C1s mother stated they would take C1 to Urgent Care. Per licensee, C1s parents arrived to the Family Child Care Home to pick up C1 and take them to urgent care.

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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Melissa Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/07/2026
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: NEPOMUCENO FAMILY CHILD CARE
FACILITY NUMBER: 195700291
VISIT DATE: 05/07/2026
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Per licensee, they followed up with C1s mother, and C1s mother informed them C1 received stitches. Per licensee, C1 returned to the Family Child Care Home on 04/27/2026. Per C1’s mother, C1 was okay to return without restrictions. During LPAs visit LPA observed C1 back in day care, and the outdoor play area where the incident occurred. LPA observed the licensee remove the wooden tree stumps from their outdoor play area. Per licensee, they will no longer use them and have moved them to an off-limit area.

There are no deficiencies issued during today’s visit. Appeal rights were provided.

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

Exit interview conducted and report was reviewed with the licensee, Rosa Nepomuceno.

NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Melissa Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026
LIC809 (FAS) - (06/04)
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