<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494932
Report Date: 10/28/2025
Date Signed: 10/28/2025 02:09:56 PM

Document Has Been Signed on 10/28/2025 02:09 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:GARZA FAMILY CHILD CAREFACILITY NUMBER:
197494932
ADMINISTRATOR/
DIRECTOR:		PETRA GARZAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 431-5065
CITY:LOS ANGELESSTATE: CAZIP CODE:
90043
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
10/28/2025
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:19 AM
MET WITH:Petra Garza, LicenseeTIME VISIT/
INSPECTION COMPLETED:
02:15 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 10/28/2025 Licensing Program Analyst (LPA) Dawn Dowling conducted an unannounced Annual Required Inspection and met with Licensee, Petra Garza. Days and hours of operation are Sunday through Saturday 12:00 am to 11:50 pm.

LPA toured the inside of the home and a census was taken. An Entrance checklist (LIC 126) was provided to Licensee at the start of today's inspection. Licensee has 5 children in care 3 are infants under 24 months of age.

Home is a 2 story home consisting of 4 Bedrooms, 3 Bathrooms, Living Room, Dining Room, Office (Isolation area); Family Room (Primary Child Care Room); Kitchen, Garage, Front Yard, Back Yard.

Licensee confirmed that the following rooms are on limit areas of the home for child care:

  • Dining Room( used for after school care children to do their homework)
  • Living Room (Only for parents to pass through to drop off children in back to child care room)-Living room has a fireplace that has 2 black screens surrounding it making it inaccessible to children in care
  • Office/Den (Isolation area for children when they are not feeling well)
  • Bathroom(Off office/Den used for children in care)
  • Family Room( Primary child care room)
  • Backyard

Page 1
NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Dawn Dowling
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2025
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 16
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 16
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: GARZA FAMILY CHILD CARE
FACILITY NUMBER: 197494932
VISIT DATE: 10/28/2025
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
26
27
28
29
30
31
32
Licensee reminded when children go outside to ensure that all dog feces is removed from outside play area as well as water down play equipment in order to ensure spider webs are not on play equipment. LPA also noticed 2 holes in the yard that could cause potential harm if a child fell in or on the hole, Licensee indicates that holes are always filled in with dirt and showed LPA bags of dirt that are kept behind the garage in order to fill in the holes that the dogs dig up.

The off limits area of the home is :

  • Downstairs bedrooms (Made inaccessible by closed doors and gates to hallway making it inaccessible to children in care)
  • Upstairs area(which is the entire second floor is off limits. There is a safety gate separating the stair casing that access the second floor from the day care area. )
  • There is a detached garage(off limits) located next to the backyard.
  • Front yard is off limits

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.

Capacity as specified on the license is being maintained.

Licensee resides in the home with her 2 minor children and mother who assists and is fingerprint cleared.

Smoking Prohibited:

Smoking is prohibited on the premises of a family child care home as specified in Health and Safety Code Section 1596.795(a)- Per Licensee she does not smoke, no one in the home smokes.

Fire Extinguisher: Must be Type 2a 10BC or 3A purchased or service every 12 months:

Licensee did not have proof that fire extinguisher was purchased or serviced within the last 12 months which will result in a Type B Deficiency

Page 2

NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Dawn Dowling
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025
LIC809 (FAS) - (06/04)
Page: 3 of 16
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: GARZA FAMILY CHILD CARE
FACILITY NUMBER: 197494932
VISIT DATE: 10/28/2025
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
26
27
28
29
30
31
32
Smoke Detector and Carbon Monoxide were tested and operable. First Aid kit was complete. There is adequate heating and ventilation for safety and comfort. Safe toys and play equipment are observed.

LPA Dowling observed following documents posted on bulletin board in living room accessible to parents:

· Facility License


· PUB 394- Notification of Parents Rights
· LIC 610A- Emergency Disaster Plan
Licensee has Disaster and Fire Drills-last one conducted on 09/14/2025 at 12:00 pm.

LPA gave Licensee the following document to post on parent board:

  • LIC 9148- Earthquake Preparedness Form

LPA reviewed Children Records and the following were in files:
  • LIC 282- Affidavit Regarding Liability Insurance
  • LIC 700- Identification and Emergency Information
  • LIC 627- Consent for Emergency Medical Treatment
  • LIC 995 A- Notification of Parents Rights
  • Immunization Records

The following were missing from children's files and discussed with Licensee:
  • 15 Minute sleeping chart for 2 of the infants in care
  • Infant Sleep Plan for newly enrolled infant in care
  • LIC 995A -One Child in Care did not have in file
  • Immunization records for 3 children in care
  • Proof of Measles, Mumps, Rubella (MMR)- for 1 child in care

Page 3
NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Dawn Dowling
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025
LIC809 (FAS) - (06/04)
Page: 4 of 16
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: GARZA FAMILY CHILD CARE
FACILITY NUMBER: 197494932
VISIT DATE: 10/28/2025
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
26
27
28
29
30
31
32
Licensee Personnel Records were reviewed and Licensee missing the following:
  • Current Pediatric CPR and First Aid Certification issued by American Red Cross or the American Heart Association or by an approved Emergency Medical Services Authority (EMSA) vendor
  • Mandated Reporter Training Certificate
  • Proof of Immunization of Measles, Mumps, Rubella (MMR), Pertussis
for both licensee and Assistant/Mom- Shelley Harris this will result in Type B Deficiency
Licensee and Assistant/ Mom- Shelley Harris has on file the following:
  • TB Clearance
  • Declination of Flu Shot

Licensee provides meals and snacks for children in care, Licensee reminded if child brings food from home to ensure it is labeled and properly stored.

Children have cots to sleep on, there are play yards for infants to sleep in, Licensee provides bedding which is washed weekly. If a child has an accident bedding is immediately removed and bedding is changed and washed.

State law prohibits baby walkers, bouncy seats, exer-saucers and any other items that fall into that category. LPA did observe a bouncer in the hallway near closed off bedroom, LPA reminded Licensee that this is an prohibited item and can not be in child care area, although it was in off limit area of home it can not be in the home Per Heath and Safety Code Section 1596.846(b)(c) states that a baby walker shall not be kept or used on the premises of a child care facility In addition, the California Code of Regulation , Title 22, Division 12, Chapter 3, Section 102417(g)(10), under Operation of Family Child Care Home; states that a baby walker shall not be allowed on the premises of a family child care home. Legislature declared that a baby walker, or time of similar nature are considered an immediate risk to the child's safety as they are inherently unsafe and not cabale of design changes that would prevent accidents.

Licensee given PROHIBITED ITEMS IN FAMILY CHILD CARE HOME FLYER and informed to remove immediately as it will result in a Type A Deficiency if not removed from premises.

Page 4

NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Dawn Dowling
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025
LIC809 (FAS) - (06/04)
Page: 5 of 16
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: GARZA FAMILY CHILD CARE
FACILITY NUMBER: 197494932
VISIT DATE: 10/28/2025
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
26
27
28
29
30
31
32
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 must be monitored every 15 minutes when sleeping, their breathing, temperature and color of skin should also be monitored. 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

Technical Advisory issued to remind Licensee to ensure any infants 24 months and under are being monitored every 15 minutes for safe sleep.

The licensee is advised to never shake a baby to prevent Shaken Baby Syndrome. LPA reminded Licensee that only children eating may be in high chairs and that car seats are utilized only for transportation, ensure that no child is left in high chair or in car seat if they fall asleep, remove immediately and place in crib/play yard.

Medication :

LPA Dowling discussed medication with Licensee, currently Licensee only gives medication that has been prescribed by child's Doctor and it is kept separate with child's name and instructions for giving medication on the label. Licensee does not have any children currently on any prescribed medication. Licensee will put on diaper cream ointment for children . Medication is inaccessible to children in care. Medication was discussed

Page 5

NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Dawn Dowling
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025
LIC809 (FAS) - (06/04)
Page: 15 of 16
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: GARZA FAMILY CHILD CARE
FACILITY NUMBER: 197494932
VISIT DATE: 10/28/2025
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
26
27
28
29
30
31
32
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.

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

Type B deficiencies were 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.

Exit interview conducted with Licensee. A copy of this report, notice of site inspection, Appeal Rights (LIC 9058), were given and explained during this inspection.

NAME OF LICENSING PROGRAM MANAGER: Raul Navarro
NAME OF LICENSING PROGRAM ANALYST: Dawn Dowling
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025
LIC809 (FAS) - (06/04)
Page: 16 of 16
Document Has Been Signed on 10/28/2025 02:09 PM - It Cannot Be Edited


Created By: Dawn Dowling On 10/28/2025 at 01:32 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: GARZA FAMILY CHILD CARE
FACILITY NUMBER: 197494932

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/28/2025

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, the licensee did not comply with the section cited above in the home does not have proof of fire extinguisher being serviced or puchased within the last 12 months which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/11/2025
Plan of Correction
1
2
3
4
Licensee will purchase a new fire extinguisher Type 2A 10 BC or 3A or have current one serviced and show LPA proof via email.
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 observation,interview and record revie, the licensee did not comply with the section cited above in [2 out of 2 persons, Licensee and Assistant do not have current mandated reporter certificate on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/11/2025
Plan of Correction
1
2
3
4
Licensee and Assistant/Mom Shelley Harris will email LPA proof of Mandated Reporter Certicate
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: 10/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/28/2025


LIC809 (FAS) - (06/04)
Page: 6 of 16
Document Has Been Signed on 10/28/2025 02:09 PM - It Cannot Be Edited


Created By: Dawn Dowling On 10/28/2025 at 01:32 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: GARZA FAMILY CHILD CARE
FACILITY NUMBER: 197494932

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/28/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

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 2 person, Licensee and Assistant/Mom Shelley Harris do not have current Pediatric First Aid, CPR Certificate on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/11/2025
Plan of Correction
1
2
3
4
Licensee and Assistant/Mom Shelley Harris will provide LPA proof of Current Pediatric First Aid, CPR via email
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(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 observation, interview and record review, the licensee did not comply with the section cited above in2 out of 2 persons, Licensee and Assistant/Mom Shelley Harris do not have current immunization record on file for Measles, Mumps, Rubella (MMR) and Pertussis which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/11/2025
Plan of Correction
1
2
3
4
Licensee and Assistant/Mom Shelley Harris will provide proof of Immunization for Measles, Mumps, Rubella (MMR) and Pertussis to LPA via email on or before the plan of correction 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.
Raul Navarro
NAME OF LICENSING PROGRAM MANAGER:
Dawn Dowling
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/28/2025


LIC809 (FAS) - (06/04)
Page: 7 of 16
Document Has Been Signed on 10/28/2025 02:09 PM - It Cannot Be Edited


Created By: Dawn Dowling On 10/28/2025 at 01:32 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: GARZA FAMILY CHILD CARE
FACILITY NUMBER: 197494932

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/28/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

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 3 out of 9 children do not have proof of immunizaion on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/11/2025
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.
Raul Navarro
NAME OF LICENSING PROGRAM MANAGER:
Dawn Dowling
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/28/2025


LIC809 (FAS) - (06/04)
Page: 8 of 16