197494021-7-25-2025-58-CC-DDOG-DJWSCE-20250725134525

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494021
Report Date: 07/25/2025
Date Signed: 07/25/2025 01:45:44 PM

Document Has Been Signed on 07/25/2025 01:45 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:	MALDONADO FAMILY CHILD CARE		FACILITY NUMBER:	197494021
ADMINISTRATOR/ DIRECTOR:	MALDONADO, CLAUDIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 642-8053
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90043
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 12	CENSUS: 11	DATE:	07/25/2025
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:55 AM
MET WITH:	Licensee, Claudia Maldonado		TIME VISIT/ INSPECTION COMPLETED:	02:00 PM

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Licensing Program Analyst (LPA) Dawn Dowling conducted an unannounced annual required inspection at the above facility on 06/25/2025 at 2:30 PM. Upon arrival, LPA disclosed the purpose of the inspection and met with Director and Licensee Claudia Maldonado came out shortly after LPA Dowling entered the home. Director guided LPA on a tour of the facility, showing LPA Dowling the infant room where LPA Dowling observed 2 infants in play yards. The Entrance Checklist – Family Child Care Homes LIC 126 was provided to the Licensee to help facilitate the inspection. Licensee's spouse was present and assisted in testing the carbon monoxide and smoke detector that is located in the kitchen. Licensee has 2 other carbon monoxide and smoke detectors in other areas of the home. There were eleven day care children present during today’s inspection. Per Licensee, there are currently 12 children enrolled in day the day care.

Due to time constraints LPA Dowling had to end the inspection and will come back another day in order to complete the inspection, a Notice of Site Visit was given to Licensee and informed to keep it posted for 30 days and LPA Dowling will return on another date in order to complete the annual inspection.

On 07/25/2025 at 9:55 am Licensing Program Analyst (LPA), Dawn Dowling conducted an unannounced Required continued Annual Inspection and was met by Director. LPA observed 2 children in living room being supervised by Staff. Director took LPA Dowling to backyard where Licensee was outside with 8 children supervising outside play. There was also 1 infant asleep making total census count of 11 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 7:00 am to 6:00 pm.

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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Dawn Dowling
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025

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: MALDONADO FAMILY CHILD CARE	FACILITY NUMBER: 197494021
	VISIT DATE: 07/25/2025

NARRATIVE

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Licensee resides in home with Husband and 1 child. Husband is fingerprint cleared.

Home is a 3 bedrooms 2 bathroom home, with laundry room, Kitchen, Living room and Dining area backyard. The off limit areas are 2 bedrooms and 1 bathroom and back portion of backyard. On limits area is Living room , Fireplace is in the living room and is made inaccessible as it is blocked off and inaccessible to children in care, 1 Bedroom used for infants have 2 play yards for infant to have their own separate sleeping area, Bathroom # 2 is used for children in care was observed to be in good repair. backyard(front portion is used for outside play) Children eat at table in backyard, play equipment observed to be age appropriate and free of any hazards. The outdoor play area in the back yard is fenced and there are no hazards to children present. .

All children were observed to be under visual supervision of staff at all times. Furniture and play equipment were inspected for age appropriateness and good repair. Telephone service utilized is a cell phone. Children have their own hooks to store their back packs and blankets. Bedding is provided and washed weekly. Napping equipment (mats) were observed. Per Director, the isolation area is located in the kitchen where child will sit on a chair or lay down and wait for parent to pick them up.

There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

The fire extinguish Type 3A 10 BC was purchased on 07/25/2025 from Costco during LPA Dowling inspection, LPA Dowling observed delivery of fire extinguisher at 1:28 pm. Director was reminded to either service fire extinguishes every year or purchase new one as contents may settle at the bottom and will not be any good when ready to use

Smoke Detector and Carbon Monoxide were tested and operable. First Aid kit was complete. There is adequate heating and ventilation for safety and comfort. There are no stairs in this home. Safe toys and play equipment are observed.

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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Dawn Dowling
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2025

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: MALDONADO FAMILY CHILD CARE	FACILITY NUMBER: 197494021
	VISIT DATE: 07/25/2025

NARRATIVE

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LPA Dowling reviewed children’s files and observed files were complete with:

LIC 282- Affidavit Regarding Liability Insurance
LIC 700 Identification and Emergency Information
LIC 627 Consent for Emergency Medical Treatment
LIC 995A Notification of Parent's Rights
Immunization Record
Infant Sleeping Chart for Infant Under 12 Months of Age Infant Sleeping Chart for Infant Under 24 Months of Age

Licensee did not have in file Immunization Record of 1 infant; Proof of immunization for Measles, Mumps, Rubella (MMR) for 1 child and informed that this deficiency will result in a Type B citation.

LPA Dowling observed following documents posted on bulletin board in hallway room accessible to parents when picking up child's personal property from cubbies/hooks:

Facility License
PUB 394- Notification of Parents Rights
LIC 9148- Earthquake Preparedness
LIC 610A- Emergency Disaster Plan

Licensee has Disaster and Fire Drills-last one conducted on 04/23/2025

Staff File reviewed and Complete.

Licensee's Mandated Reporter Training was completed on 10/31/2023
Pediatric CPR/First Aid taken by American Red Cross was completed on 11/05/2023

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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Dawn Dowling
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2025

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: MALDONADO FAMILY CHILD CARE	FACILITY NUMBER: 197494021
	VISIT DATE: 07/25/2025

NARRATIVE

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Licensee and Director have current Immunization Record on file along with Proof of TB test with negative results
Licensee and Director provided LPA Dowling declination letter for flu shot, LPA Dowling will place in file upon return to office.

LPA Dowling observed children in care were in caring and nurturing environment and treated with dignity and respect.

State law prohibits baby walkers, bouncy seats, exer-saucers and any other items that fall into that category. LPA did not observe any prohibit items in home.

Criminal Record Statement Family Child Care Homes
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.

LPA Dowling advised licensee infants 24 months of age and under must be monitored every 15 minutes when sleeping, their breathing, temperature and color of skin should also be monitored, log in sleeping chart and kept in file. Safe Sleep regulation was discussed with licensee as well as the Child Care Licensing Safe Sleep webpage listed below that licensee can utilize as an additional resource.https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep

The licensee is advised to never shake a baby to prevent Shaken Baby Syndrome.

Licensee and Directory reminded that only children eating may be in high chairs and that car seats are utilized only for transportation.

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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Dawn Dowling
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2025

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: MALDONADO FAMILY CHILD CARE	FACILITY NUMBER: 197494021
	VISIT DATE: 07/25/2025

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Medication :
LPA Dowling discussed medication with Licensee, currently Licensee does not give medication, only Epi Pen if needed. Licensee reminded that any Epi Pen used is to be kept separate with child's name and instructions for giving medication on the label. Medication is inaccessible to children in care.

Incidental Medical Services (IMS) policy
For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm

LPA and Licensee discussed 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.

Type B deficiencies was cited during today's inspection (see LIC 809Ds). The Licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days

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NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Dawn Dowling
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/25/2025 01:45 PM - It Cannot Be Edited

Created By: Dawn Dowling On 07/25/2025 at 01:19 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: MALDONADO FAMILY CHILD CARE	FACILITY NUMBER: 197494021
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/25/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102418(a)

Immunizations

(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above in 2 out of 6 children files reviewed did not have proof of immunization on file which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/08/2025
	Plan of Correction
1 2 3 4	Licensee will provide LPA Dowling with proof of child # 1 immunization record and proof of child # 2 having Measles, Mumps, Rubella (MMR) immunization on or before due date 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.

	Raul Navarro
NAME OF LICENSING PROGRAM MANAGER:

	Dawn Dowling
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2025

LIC809 (FAS) - (06/04)

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