197406852-12-19-2025-58-CC-JLIY-DPHUFK-20251219143251

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197406852
Report Date: 12/19/2025
Date Signed: 12/19/2025 02:33:19 PM

Document Has Been Signed on 12/19/2025 02:33 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	DIAZ-ISLAS FAMILY CHILD CARE		FACILITY NUMBER:	197406852
ADMINISTRATOR/ DIRECTOR:	DIAZ-ISLAS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 709-0423
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 9	CENSUS: 4	DATE:	12/19/2025
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Licensee Angelica Diaz-Islas		TIME VISIT/ INSPECTION COMPLETED:	02:37 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 12/29/25 at 9am Licensing Program Analysts (LPA's), Jeanine Lipsey and Christina Nunez conducted an unannounced Required Annual Inspection and was met by Licensee Angelica Diaz-Islas. Entrance checklist was provided. LPA observed 4 children in care being supervised by 2 staff. Capacity as specified on the license is being maintained. Days and hours of operation are Monday through Friday 7 am to 5:30 pm. LPA's toured the home inside and out. LPA's observed the following required postings: License, PUB 394 Notification of Parents’ Rights Poster, and LIC 9148 Earthquake Preparedness Checklist. LPA observed LIC 9040 Children Roster, LIC610A Emergency Disaster Plan, and the disaster/fire drill log was not being documented. LPA reminded all LIC9213 Notice of Site Visits shall be posted for 30 days after each site visit. LPA advised, any licensing report documenting a Type A citation must be posted for 30 days. Licensee live in son and family member who has been in the home for one month was present without finger print clearance. Due to background clearance not being done, A Type A will be cited. LPA Jeanine Lipsey informed licensee Angelica Diaz-Islas that this report dated 12/19/25 documents One Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, Safety, or personal rights of children in care. page 1 of 2

NAME OF LICENSING PROGRAM MANAGER: Betty Bell
NAME OF LICENSING PROGRAM ANALYST: Jeanine Lipsey
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025

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 13

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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Document Has Been Signed on 12/19/2025 02:33 PM - It Cannot Be Edited

Created By: Jeanine Lipsey On 12/19/2025 at 11:08 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: DIAZ-ISLAS FAMILY CHILD CARE	FACILITY NUMBER: 197406852
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/19/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102370(k)

Criminal Record Clearance

(k) The licensee shall maintain documentation of criminal record clearances or criminal record exemptions of employees, volunteers that require fingerprinting and non-client adults residing in the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation interview & record review, the licensee did not comply with the section cited above in that Licensee familiy member Samantha Resse has been visiting for 1 month and does not have finger print clearance which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 12/22/2025
	Plan of Correction
1 2 3 4	Licensee will have the finger prints completed by POC 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.

	Betty Bell
NAME OF LICENSING PROGRAM MANAGER:

	Jeanine Lipsey
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025

LIC809 (FAS) - (06/04)

Page: 3 of 13

Document Has Been Signed on 12/19/2025 02:33 PM - It Cannot Be Edited

Created By: Jeanine Lipsey On 12/19/2025 at 11:08 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: DIAZ-ISLAS FAMILY CHILD CARE	FACILITY NUMBER: 197406852
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/19/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)

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: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation , the licensee did not comply with the section cited above in that Need plug covers in living room, outside playroom, kitchen, need safety gate near dog area, both entries to hall ways, both storage areas, remove laundry detergent or gate or barrier before the washer and dryers, safety locks on kitchen cabinets and drawers, lock on outside cabinet which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/02/2026
	Plan of Correction
1 2 3 4	Licensee will have corrections completed by poc 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
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in that Licensee and staff missing mandated reporter training which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/02/2026
	Plan of Correction
1 2 3 4	Training will be completed by poc 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.

	Betty Bell
NAME OF LICENSING PROGRAM MANAGER:

	Jeanine Lipsey
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025

LIC809 (FAS) - (06/04)

Page: 4 of 13

Document Has Been Signed on 12/19/2025 02:33 PM - It Cannot Be Edited

Created By: Jeanine Lipsey On 12/19/2025 at 11:08 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: DIAZ-ISLAS FAMILY CHILD CARE	FACILITY NUMBER: 197406852
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/19/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited


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

Type B

Section Cited

HSC

1597.622(a)(1)

(1) 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. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in Licensee and staff missing immunizations which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/19/2026
	Plan of Correction
1 2 3 4	Licensee will send proof of immunizations by POC 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.

	Betty Bell
NAME OF LICENSING PROGRAM MANAGER:

	Jeanine Lipsey
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025

LIC809 (FAS) - (06/04)

Page: 5 of 13

Document Has Been Signed on 12/19/2025 02:33 PM - It Cannot Be Edited

Created By: Jeanine Lipsey On 12/19/2025 at 11:08 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: DIAZ-ISLAS FAMILY CHILD CARE	FACILITY NUMBER: 197406852
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/19/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited


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

Type B

Section Cited

CCR

102417(m)(3)

(3) A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in that All files missing LIC 282 Affidavit which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/02/2026
	Plan of Correction
1 2 3 4	Licensee will send proof of documentation via email.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Betty Bell
NAME OF LICENSING PROGRAM MANAGER:

	Jeanine Lipsey
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025

LIC809 (FAS) - (06/04)

Page: 6 of 13

Document Has Been Signed on 12/19/2025 02:33 PM - It Cannot Be Edited

Created By: Jeanine Lipsey On 12/19/2025 at 11:08 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: DIAZ-ISLAS FAMILY CHILD CARE	FACILITY NUMBER: 197406852
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/19/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(2)(D)(c)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review the licensee did not comply with the section cited above in that 15 min checks are not being documented which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/02/2026
	Plan of Correction
1 2 3 4	Licensee will send proof of 15 minute checks via email by POC 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.

	Betty Bell
NAME OF LICENSING PROGRAM MANAGER:

	Jeanine Lipsey
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025

LIC809 (FAS) - (06/04)

Page: 7 of 13

Document Has Been Signed on 12/19/2025 02:33 PM - It Cannot Be Edited

Created By: Jeanine Lipsey On 12/19/2025 at 12:15 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: DIAZ-ISLAS FAMILY CHILD CARE	FACILITY NUMBER: 197406852
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/19/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(1)

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: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date:
	Plan of Correction
1 2 3 4

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.

	Betty Bell
NAME OF LICENSING PROGRAM MANAGER:

	Jeanine Lipsey
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025

LIC809 (FAS) - (06/04)

Page: 12 of 13

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: DIAZ-ISLAS FAMILY CHILD CARE	FACILITY NUMBER: 197406852
	VISIT DATE: 12/19/2025

NARRATIVE

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Also, LPA's Jeanine Lipsey and Christina Nunez informed the licensee to provide a copy of this licensing report dated 12/19/25 that documents any Type A citation to parents/guardian 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 (LIC9924), or written statement, must be placed in the child's file for verification.

Due to time constraints the visit will be completed at a later date.

Exit interview conducted and report was reviewed with the Licensee Angelica Diaz-Islas. A notice of site visit was given and advised Licensee that it must remain posted for 30 days.

Page 2 of 2

NAME OF LICENSING PROGRAM MANAGER: Betty Bell
NAME OF LICENSING PROGRAM ANALYST: Jeanine Lipsey
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025

LIC809 (FAS) - (06/04)

Page: 13 of 13