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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493037
Report Date: 07/23/2025
Date Signed: 08/18/2025 03:49:43 PM

Document Has Been Signed on 08/18/2025 03:49 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 RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:BELLER FAMILY CHILD CAREFACILITY NUMBER:
197493037
ADMINISTRATOR/
DIRECTOR:		BELLER, ALBANAIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 633-1814
CITY:VENICESTATE: CAZIP CODE:
90291
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
07/23/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:39 AM
MET WITH:Albanai BellerTIME VISIT/
INSPECTION COMPLETED:
01:20 PM
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On 7/23/2025, Licensing Program Analyst (LPA) Ranita Richmond conducted an unannounced visit to the above-named home. The reason for the visit is to conduct the Required 3-year Inspection. LPA was greeted by assistant Ashley Guzman. Licensee arrived at 10:16am due to dropping off son at summer camp. Licensee left the home at 11:45am to pick up son from summer camp and returned at 12:40pm. LPA observed 7 children, being supervised and cared for by licensee’s assistant. Hours of operation are Monday through Friday, 8:30am –4:30pm. Licensee is not open for overnight and weekend care. Licensee provides snacks and water.

LPA Richmond toured the home inside and outside for a Health and Safety inspection.

LPA Richmond confirmed that the home is a single story home. The home consists of four bedrooms, two bathrooms, living room, kitchen, dining room, laundry room, converted detached garage with additional half bathroom, and fenced back yard.

The ON LIMIT AREAS are as follows: Living room (napping area/isolation area), bathroom #1, dining room (eating area), converted detached garage (additional activity space), and fenced back yard.

The OFF-LIMIT AREAS are as follows: kitchen, bedrooms #1, # 2, #3, #4, laundry room, and bathroom #2.

Children and parents enter through the side gate of the home. Upon entrance you are in the gated back yard where children are dropped off and picked up. Inside the backyard is the converted detached garage. If you enter the home through the front door you are in the living room. Through the living room to the left is an entryway that leads to a hallway. Inside this hallway is bedrooms #1, #2, #3, & #4 and bathrooms #1&2. Inside the hallway to the right is the laundry room. To the left of the laundry room is a door that leads to the side of the house. In the laundry room to the right is the kitchen. Through the kitchen to the right is the dining room. To the right of the dining room is the living room.
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NAME OF LICENSING PROGRAM MANAGER: Maureen Neal
NAME OF LICENSING PROGRAM ANALYST: Ranita Richmond
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/23/2025
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)
Page: 2 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 RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: BELLER FAMILY CHILD CARE
FACILITY NUMBER: 197493037
VISIT DATE: 07/23/2025
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Licensee is aware that the children must nap, toilet, and have meals in the home.

LPA Richmond observed a fully charged 2A:10B:C Fire Extinguisher in the kitchen.

There are no firearms or ammunition on the premises. There are no pools, ponds or other bodies of water on the premises.

LPA Richmond observed age-appropriate toys, books and furnishings. Furniture and equipment are in good condition, free of sharp, loose, or pointed parts.

During walkthrough LPA observed disinfectant wipes, off spray, and suntan lotion in drawers of bathroom #1, beauty and hygiene items in medicine cabinet and under the cabinet in bathroom #1. Type B citation issued. LPA observed knife block housed on kitchen counter with knives stored inside the block. Type B citation cited. See LIC 809D.

Licensee advised LPA that structural changes in the way of wall brick wall being shortened and gate removal have occurred in the gated backyard in Summer of 2024. LPA asked if construction was reported to the Department. Licensee stated no report of construction was made to the Department. Type B citation cited. See LIC 809D.

LPA reviewed 0 of the children’s files due to licensee file system is not in order and all files are incomplete and missing documentation. Type B citations issued. See LIC 809D.

LPA Richmond observed the licensee has a current 1st aid/cpr completed on 04/08/24. Licensee is unable to provide a certificate of completion for mandated reporter training. Type B citation cited. See LIC 809D.



LPA reviewed 0 staff files due to licensee file system is not in order and all files are incomplete and missing documentation. Type B citations cited. See LIC 809D.

LPA reviewed guardian background check and determined that assistant Ashley Guzman is not associated with Beller FCC, but has fingerprint clearance. Type A citation cited. See LIC 809D.

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NAME OF LICENSING PROGRAM MANAGER: Loyce Phillips
NAME OF LICENSING PROGRAM ANALYST: Ranita Richmond
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2025
LIC809 (FAS) - (06/04)
Page: 3 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 RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: BELLER FAMILY CHILD CARE
FACILITY NUMBER: 197493037
VISIT DATE: 07/23/2025
NARRATIVE
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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page 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. During file review LPA observed missing infant sleep charts. Type B citation cited. LPA provided licensee with infant sleep charts for daily completion.

Incidental Medical Services (IMS) are not currently being provided.



Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA Richmond reminded Licensee of the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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

LPA provided applicant with the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. LPA Richmond gave applicant a packet of all required forms, and posters and reviewed following forms:

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NAME OF LICENSING PROGRAM MANAGER: Loyce Phillips
NAME OF LICENSING PROGRAM ANALYST: Ranita Richmond
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2025
LIC809 (FAS) - (06/04)
Page: 4 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 RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: BELLER FAMILY CHILD CARE
FACILITY NUMBER: 197493037
VISIT DATE: 07/23/2025
NARRATIVE
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CHILDREN'S RECORDS REQUIREMENTS:

· LIC 700 Identification and Emergency Information


· LIC 627 Consent for Emergency Medical Treatment
· LIC 282 Affidavit Regarding Liability Insurance
· LIC 9150 Parent Notification Additional Children in Care
· LIC 9927 Individual Infant Sleeping Plan
· LIC 995A Notification of Parent’s Rights
· LIC 613A Personal Rights
· Immunization Record

FACILITY RECORDS:
· LIC 624B Unusual Incident/Injury Report
· LIC 9040 Child Care Facility Roster
· LIC 9052 Employee Rights,
· LIC 9108 Statement Acknowledging Requirement to Report Child Abuse
· LIC 9149 Property Owner/Landlord Consent Form
· LIC 9151 Property Owner/Landlord Notification Form
· Proof of current pediatric CPR and First Aid Certificates
· Copy of your deed or lease/rental agreement
· Documentation of Fire and Disaster drills
· Proof of immunizations against pertussis (TDAP), measles (MMR), and influenza
· Mandated Reporter certificate – www.mandatedreporterca.com – must be renewed every two (2) years.

FORMS TO BE POSTED


· LIC203 Facility License
· LIC 610A Emergency Disaster Plan
· LIC 9148 Earthquake Preparedness Checklist
· PUB394 Notification of Parents Rights Poster


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NAME OF LICENSING PROGRAM MANAGER: Loyce Phillips
NAME OF LICENSING PROGRAM ANALYST: Ranita Richmond
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2025
LIC809 (FAS) - (06/04)
Page: 5 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 RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: BELLER FAMILY CHILD CARE
FACILITY NUMBER: 197493037
VISIT DATE: 07/23/2025
NARRATIVE
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In addition, LPA Richmond informed applicant of the following:

o There is an effective 24/7 ban on smoking tobacco in a home that is licensed as a family day care home, and in those areas of the family day care home where children are present.
o Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
o Saucer chairs, bouncers, walkers, or any similar items are prohibited.
o All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
o LPA provided and advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

LPA Ranita Richmond informed licensee Albanai Beller that this report dated 7/23/25 documents one Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Ranita Richmond informed the licensee to provide a copy of this licensing report dated 7/23/25 that documents any Type A citation to parents/guardians 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 (LIC 9224), or other written statement, must be placed in the child's file for verification.

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

An exit interview was completed with licensee Albanai Beller. A copy of report and appeal rights were provided to licensee.

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

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NAME OF LICENSING PROGRAM MANAGER: Loyce Phillips
NAME OF LICENSING PROGRAM ANALYST: Ranita Richmond
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2025
LIC809 (FAS) - (06/04)
Page: 6 of 13
Document Has Been Signed on 08/18/2025 03:49 PM - It Cannot Be Edited


Created By: Ranita Richmond On 08/18/2025 at 12:14 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: BELLER FAMILY CHILD CARE
FACILITY NUMBER: 197493037

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/23/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Subsequent to licensure, a person...(b)who is not exempt from fingerprinting, shall be fingerprinted....prior to employment.
This requirement is not met as evidenced by:
Staff has fingerprint clearance that is not associated with current FCC.
Deficient Practice Statement
1
2
3
4
Based on interview and record review, the licensee did not comply with the section cited above staff possesses fingerprint clearance that is not associated with current FCC poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/19/2025
Plan of Correction
1
2
3
4
Licensee will ensure that all staff and or volunteers have fingerprint clearance and are associated with FCC.
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.
Loyce Phillips
NAME OF LICENSING PROGRAM MANAGER:
Ranita Richmond
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/18/2025


LIC809 (FAS) - (06/04)
Page: 7 of 13
Document Has Been Signed on 08/18/2025 03:49 PM - It Cannot Be Edited


Created By: Ranita Richmond On 08/18/2025 at 12:21 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: BELLER FAMILY CHILD CARE
FACILITY NUMBER: 197493037

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/23/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)

On or before March 30, 2018....a licensed child care provider, administrator, or employee.....shall complete renewal mandated reporter training every two years.....
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 file review was not completed and mandated reporter completion certificates were not provided for review which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/01/2025
Plan of Correction
1
2
3
4
Licensee and assistants will complete mandated reporter training and email certificate of completion to LPA for file.
Type B
Section Cited
CCR
101416.1(a)
A personnel records shall be maintained on each employee

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 personnel files were not provided which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/02/2025
Plan of Correction
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2
3
4
Licensee will complete and provide for review by LPA personnel files for all employees.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Loyce Phillips
NAME OF LICENSING PROGRAM MANAGER:
Ranita Richmond
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/18/2025


LIC809 (FAS) - (06/04)
Page: 8 of 13
Document Has Been Signed on 08/18/2025 03:49 PM - It Cannot Be Edited


Created By: Ranita Richmond On 08/18/2025 at 12:33 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: BELLER FAMILY CHILD CARE
FACILITY NUMBER: 197493037

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/23/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
102416.1(a)(10)

A personnel records shall be maintained....A signed copy of notice of employee's rights...
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 personnel files were not provided which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/01/2025
Plan of Correction
1
2
3
4
Licensee will ensure that personnel files include a signed copy of employee's rights for all employees
Type B
Section Cited
CCR
102416.3(a)(4)
Prior to making any alterations or additions to family childcare home or grounds, the licensee shall notify the Department of proposed change....construction

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and interview, the licensee did not comply with the section cited above wall was lowered in the gated backyard which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/18/2025
Plan of Correction
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2
3
4
Licensee will provide work order to Department for review. Licensee will notify the Department prior to any changes to family childcare home.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Loyce Phillips
NAME OF LICENSING PROGRAM MANAGER:
Ranita Richmond
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/18/2025


LIC809 (FAS) - (06/04)
Page: 9 of 13
Document Has Been Signed on 08/18/2025 03:49 PM - It Cannot Be Edited


Created By: Ranita Richmond On 08/18/2025 at 12:41 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: BELLER FAMILY CHILD CARE
FACILITY NUMBER: 197493037

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/23/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)(A)

The home shall be free from defects....cleaning compounds, medicine...which could pose a danger...shall be made inaccessible to children
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 health and hygiene items in medicine cabinet and a knives in the nife block on the kitchen counter which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/01/2025
Plan of Correction
1
2
3
4
Licensee will house medications and knifes in locked areas inaccessible to children.
Type B
Section Cited
CCR
102417(m)(3)
The licensee...shall maintain signed affidavits by each child....home does not carry insurance or bond.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
fBased on record review, the licensee did not comply with the section cited above children's files were not provided which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/01/2025
Plan of Correction
1
2
3
4
Licensee will provide each parenet with LIC 282 for signing and file. Licensee will provide copy to LPA 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.
Loyce Phillips
NAME OF LICENSING PROGRAM MANAGER:
Ranita Richmond
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/18/2025


LIC809 (FAS) - (06/04)
Page: 10 of 13
Document Has Been Signed on 08/18/2025 03:49 PM - It Cannot Be Edited


Created By: Ranita Richmond On 08/18/2025 at 12:49 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: BELLER FAMILY CHILD CARE
FACILITY NUMBER: 197493037

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/23/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(g)

The licensee shall document each child's immunizations....
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 children's file were not provided which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/01/2025
Plan of Correction
1
2
3
4
Licensee will request immunizations for each child enrolled and place in file for review. Licensee will provide copies to LPA for review via email.
Type B
Section Cited
CCR
102419(d)
At time of acceptance for each child into care....parent or authorized representative shall be provided with a copy of parent's rights...

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 abovechildren's files were not provided which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/01/2025
Plan of Correction
1
2
3
4
Licensee will provide each authorized representative with a copy of parent's rights. Parents will sign and place in file for review. LIcensee will provide copy to LPA 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.
Loyce Phillips
NAME OF LICENSING PROGRAM MANAGER:
Ranita Richmond
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/18/2025


LIC809 (FAS) - (06/04)
Page: 11 of 13
Document Has Been Signed on 08/18/2025 03:49 PM - It Cannot Be Edited


Created By: Ranita Richmond On 08/18/2025 at 12:54 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: BELLER FAMILY CHILD CARE
FACILITY NUMBER: 197493037

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/23/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102421(b)

Licensee shall maintain in each child's record, a copy of emergency information record...
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 children's file not provided which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/01/2025
Plan of Correction
1
2
3
4
Licensee will ensure each child's file will contain a copy of emergency information. Licensee will provide copy to LPA via email.
Type B
Section Cited
CCR
102425(c)

Infant sleep plan for all infants up to 12 months of age....
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 children's files not provided which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/02/2025
Plan of Correction
1
2
3
4
Licensee will ensure infant children up to 12 months of age file contains an updated infant sleep plan for review. Licensee will provide LPA a copy 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.
Loyce Phillips
NAME OF LICENSING PROGRAM MANAGER:
Ranita Richmond
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/18/2025


LIC809 (FAS) - (06/04)
Page: 12 of 13
Document Has Been Signed on 08/18/2025 03:49 PM - It Cannot Be Edited


Created By: Ranita Richmond On 08/18/2025 at 01:00 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: BELLER FAMILY CHILD CARE
FACILITY NUMBER: 197493037

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/23/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)

Providers shall supervise infants while they are sleeping....and document
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 children's files not provided which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/01/2025
Plan of Correction
1
2
3
4
Licensee will provide infant sleep logs for all infants up to 24 months of age. Licensee will provide logs to LPA via email
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.
Loyce Phillips
NAME OF LICENSING PROGRAM MANAGER:
Ranita Richmond
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/18/2025


LIC809 (FAS) - (06/04)
Page: 13 of 13