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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197414248
Report Date: 02/27/2025
Date Signed: 03/07/2025 09:55:31 AM

Document Has Been Signed on 03/07/2025 09:55 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 RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:CHAVEZ FAMILY CHILD CAREFACILITY NUMBER:
197414248
ADMINISTRATOR/
DIRECTOR:		CHAVEZ, MARIA & SUSANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 398-4910
CITY:CULVER CITYSTATE: CAZIP CODE:
90230
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
02/27/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:05 PM
MET WITH:Maria Chavez/ Susana OrtizTIME VISIT/
INSPECTION COMPLETED:
03:24 PM
NARRATIVE
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On 2/27/25 Licensing Program Analyst (LPA) Ranita Richmond arrived at the above named home for an unannounced case management deficiencies visit. LPA was met by Maria Chavez and Susana Ortiz. LPA observed 2 children being cared for and supervised by licensees.

LPA observed disinfectant wipes and spray in basket on shelf accessible to children in care in the living room. LPA observed shampoo, conditioners, and other beauty and hygiene products in the bath/shower, which were accessible to children in care. LPA observed the bathroom cabinet which housed cleaning supplies to be open and cleaning products were accessible to children in care. Type B citation issued. Repeat violation.
LPA requested infant sleep log for children in care. Licensee advised that the infant sleep logs have not been created for infant children in care. Type B citation issued. Repeat violation.

Deficiencies were cited today, per Title 22 Regulations and Health and Safety Codes. See LIC 809D. See LIC 421FC.

An exit interview was conducted and a copy of report and appeal rights were provided to licensee.

Notice of Site Visit provided and required to be posted for 30 days.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Ranita Richmond
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2025
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 2
Document Has Been Signed on 03/07/2025 09:55 AM - It Cannot Be Edited


Created By: Ranita Richmond On 02/27/2025 at 01:40 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: CHAVEZ FAMILY CHILD CARE
FACILITY NUMBER: 197414248

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/13/2025
Section Cited
CCR
102417(g)(4)

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102417 Operation of A Family Child Care Home(g) The home shall be free from ...conditions which might endanger a child. ... (4) ... cleaning compounds, ...shall be stored where they are inaccessible to children. This requirement is not met as evidenced by:
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Licensee will place all cleaning compounds, disinfectants, and other hazardous items where they are inacessible to children in care at all times.
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LPA observed disinfectant wipes and spray in basket on shelf accessible to children in care in the living room, shampoo, conditioners, and other beauty and hygiene products in the bath/shower, and bathroom cabinet open and cleaning products were accessible to children.
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Type B
03/13/2025
Section Cited
CCR102425(j)(2)

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102425 Infant Safe Sleep The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:

This requirement is not met as evidenced by:
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Licensee will complete and keep infant sleep log on file for all children 24 months of age and under at all times.
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Licensee has not created infant sleep logs for children in care.
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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.
SUPERVISOR'S NAME:Claudia Escobedo
LICENSING EVALUATOR NAME:Ranita Richmond
LICENSING EVALUATOR SIGNATURE:
DATE: 02/27/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2025


LIC809 (FAS) - (06/04)
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