197415262-5-23-2025-58-CC-LHEZ-DGXV75-20250523161034

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197415262
Report Date: 05/23/2025
Date Signed: 05/23/2025 04:10:52 PM

Document Has Been Signed on 05/23/2025 04:10 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:	BONILLA FAMILY CHILD CARE		FACILITY NUMBER:	197415262
ADMINISTRATOR/ DIRECTOR:	BONILLA, MAYRA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 491-3296
CITY:	NORTH HILLS	STATE: CA	ZIP CODE:	91343
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 11	DATE:	05/23/2025
TYPE OF VISIT:	Case Management - Annual Continuation	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:45 AM
MET WITH:	Mayra Bonilla, Licensee		TIME VISIT/ INSPECTION COMPLETED:	04:30 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	Licensing Program Analyst (LPA) Lilia Hernandez conducted an unannounced annual continuation inspection to the above facility on 04/29/2025. LPAs arrived at the facility at 11:45AM, identified self and met with Mayra Bonilla, Licensee, who guided analyst on a tour of the facility. Licensee was provided with a copy of the LIC 126 Entrance Checklist to help facilitate the inspection. Facility operation hours are Monday to Friday from 7:00AM to 5:30PM. Capacity as specified on the license is being maintained. LPA observed 2 infants and 9 preschool age children in care. LPA also observed Assistant and Licensee’s Spouse present. On 04/30/2025, during the initial 3 year required annual, Licensee was not present and out of the country. Licensee kept the facility open and was being operated by the Assistant and Licensee’s Spouse. LPA reminded licensee that Section 102417(a) Operation of a Family Child Care Home states the licensee shall be present in the home and shall ensure that children in care are supervised at all times. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day. On 04/30/2025, Licensee adult son was also present and did not have a criminal record clearance. Licensee stated that adult son did not have a criminal background clearance because her son has autism. During today’s visit, LPA was able to verify that all adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. ---Page 1 of 4

NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Lilia Hernandez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2025

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BONILLA FAMILY CHILD CARE	FACILITY NUMBER: 197415262
	VISIT DATE: 05/23/2025

NARRATIVE

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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.

The family child care home is a 3 bedroom, 3 bathroom, living room, dining room, and kitchen. Current facility sketch reviewed, and Licensee confirmed that 1 bedroom in the home is used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by doors remain closed and locked.

Per Licensee, there is a firearm on the premises. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible. All poisons are kept in a locked storage area. No poisons were observed during the inspection.

There is a working fire extinguisher that was purchased on 03/25/2025. LPA observed a smoke detector and carbon monoxide detector in the home that were tested and operable. LPA also observed adequate heating and ventilation for safety and comfort.

There are currently 2 infant’s in care. Licensee was not able to provide safe sleep documentation for infants in care. Licensee was not able to provide safe sleep log for infants in care.
LPA discussed the safe sleep regulations with licensee discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. Licensee disclosed that infant equipment is replaced yearly.

Licensee was reminded that children in care are to be supervised at all times and made aware that children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. ---Page 2 of 4

NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Lilia Hernandez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2025

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BONILLA FAMILY CHILD CARE	FACILITY NUMBER: 197415262
	VISIT DATE: 05/23/2025

NARRATIVE

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The outdoor area accessible to children is the backyard. All other outdoor areas are inaccessible by a gate with a lock. LPA observed no swimming pool or other bodies of water on the premises.

LPA reviewed a sample of children’s files and observed files with LIC700 Identification and Emergency Information completed and signed, LIC267 Consent for Medical Treatment completed and signed, LIC995A Notification of Parents’ Rights signed, and Immunization records on file. LPA also observed completed LIC 9224 Acknowledgment of Licensing Reports in each child’s file for the Type A deficiency cited on 04/30/2025.

Licensee had a facility roster of the children in care that was observed to be incomplete. Facility roster was missing child’s address, physician’s name/phone number, and date of enrollment. An emergency fire/disaster drill was completed within the last 6 months. Last documented fire/disaster drill was on 04/15/2025. Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. Licensee was not able to provide proof of a completed LIC610A Emergency Disaster Plan during the inspection.

Licensee’s Mandated Reporter Training was completed on 04/16/2024. Licensee’s pediatric CPR/First Aid expires on 03/2026. Licensee did not have proof of TB clearance or yearly influenza vaccine on file.

Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC 9052- Employee Rights, 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 and current Mandated Reporter Training Certificate. Assistant #1 did not have proof of immunization against measles, pertussis, or influenza. Licensee's spouse who works form home did not have proof of immunization against measles, pertussis, influenza, or TB clearance in file.

Incidental Medical Services (IMS) policy was discussed. 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/.
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NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Lilia Hernandez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2025

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BONILLA FAMILY CHILD CARE	FACILITY NUMBER: 197415262
	VISIT DATE: 05/23/2025

NARRATIVE

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When a child shows signs of illness, the child shall be separated from other children and the nature of the illness determined. If it is a communicable disease, the child shall be separated from other children until the infectious stage is over.

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.

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/inspection-process.

Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22.

During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

The Notice of Site Visit must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview conducted and report was reviewed with Mayra Bonilla, Licensee.
---Page 4 of 4

NAME OF LICENSING PROGRAM MANAGER: Rita Ramos
NAME OF LICENSING PROGRAM ANALYST: Lilia Hernandez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/23/2025 04:10 PM - It Cannot Be Edited

Created By: Lilia Hernandez On 05/23/2025 at 02:51 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: BONILLA FAMILY CHILD CARE	FACILITY NUMBER: 197415262
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/23/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(9)

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: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. 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 was not able to provide proof of a completed LIC610A Emergency Disaster Plan during the inspection which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/06/2025
	Plan of Correction
1 2 3 4	Per Licensee, a copy of the completed LIC610A Emergency Disaster Plan will be submitted to LPA via email by POC due date. Licensee will also have the completed LIC610A Emergency Disaster Plan available for review during inspections.

Type B

Section Cited

HSC

1597.622(c)

Administration of Child Day Care Licensing

(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home. 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 did not have proof of yearly influenza vaccine. Assistant #1 did not have proof of immunization against measles, pertussis, or influenza. Licensee's spouse who works form home did not have proof of immunization against measles, pertussis, or influenza. Licensee spouse did not have TB clearance in file which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/23/2025
	Plan of Correction
1 2 3 4	Per Licensee, proof of immunization against measles, pertussis, or influenza, and TB clearance will be submitted to LPA via email by POC due date. Licensee will also have proof of immunization against measles, pertussis, or influenza, and TB clearance available for review during inspections.

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

	Rita Ramos
NAME OF LICENSING PROGRAM MANAGER:

	Lilia Hernandez
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2025

LIC809 (FAS) - (06/04)

Page: 6 of 7

Document Has Been Signed on 05/23/2025 04:10 PM - It Cannot Be Edited

Created By: Lilia Hernandez On 05/23/2025 at 02:51 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: BONILLA FAMILY CHILD CARE	FACILITY NUMBER: 197415262
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/23/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(8)

Operation of A Family Child Care Home

(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. 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 had a facility roster of the children in care that was observed to be incomplete. Facility roster was missing child’s address, physician’s name/phone number, and date of enrollment which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/06/2025
	Plan of Correction
1 2 3 4	Per Licensee, a completed LIC9040 Facility Roster will be submitted to LPA Hernandez by POC due date. Licensee will also have the completed LIC9040 Facility Roster available for review during inspections.

Type B

Section Cited

CCR

102425(j)(2)(D)

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: 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 was not able to provide safe sleep documentation for infants in care. Licensee was not able to provide safe sleep log for infants in care which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/06/2025
	Plan of Correction
1 2 3 4	Per Licensee, sleep logs dated 05/27/2025 through 06/06/2025 will be submitted to LPA by POC due date. Licensee will also have completed and current infant sleep logs available for review during inspections.

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

	Rita Ramos
NAME OF LICENSING PROGRAM MANAGER:

	Lilia Hernandez
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2025

LIC809 (FAS) - (06/04)

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