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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495298
Report Date: 06/18/2025
Date Signed: 07/01/2025 04:08:32 PM

Document Has Been Signed on 07/01/2025 04:08 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:MEDINA FAMILY CHILDCAREFACILITY NUMBER:
197495298
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 6TOTAL ENROLLED CHILDREN: 6CENSUS: 6DATE:
06/18/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Beatriz MedinaTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 06/18/2025 Licensing Program Analysts (LPA) Judy Laureano and Cristina Castellanos conducted announced inspection with applicant Beatriz Medina. The purpose of this inspection is to ensure the standards for a Family Child Care Home are being met in accordance to California Tittle 22 Regulations and California Health and Safety Codes.

The applicant is applying for a Large Family Child Care Home license for a max capacity of 12. Application is an increase of capacity application. Applicant has been licensed for a Small FCCH as of 12/29/2023. Control of property was submitted to the El Segundo Child Care Regional Office for review. Landlord notification is on file.

Per the application, at this time, the ages the applicant wishes to provide services for, are children 3 months to 5 years old- Monday through Friday from 7:30 a.m. to 5:30 p.m. Applicant is not available for overnight or weekend care. Applicant was informed that any changes to ages, hours and days of operation shall be submitted to the department via LIC 279 approval prior to initiation of changes.

LPAs toured the home inside and outside. The home is single family unit with a living room, dining room, bedroom 1 and bedroom 2, bathroom, kitchen and laundry room. LPAs observed an attached garage that will be used as extra activity space.

Living in the home is applicant with one additional adult and one minor child. Present during today’s inspection was applicant and applicant’s husband.

Parents will access the home through the side door of the home. Entering the side door, you are led to a small entryway that leads to a covered laundry room. Fire pull station with signage was observed. Next to the side entrance LPAs observed the extra activity space that is use for day care space. LPA observed children size tables and chairs, changing table and arts and craft materials. LPAs observed a working fire extinguisher and smoke and carbon monoxide detector.

NAME OF LICENSING PROGRAM MANAGER: Maureen Neal
NAME OF LICENSING PROGRAM ANALYST: Judy Laureano
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/18/2025
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 RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MEDINA FAMILY CHILDCARE
FACILITY NUMBER: 197495298
VISIT DATE: 06/18/2025
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Next to the extra activity space, LPAs observed and inspected. LPAs observed all kitchen cabinets to have safety latches making the content inaccessible to the children in care. Refrigerator, stove and counter space were observed and inspected. Knives and sharp objects were observed in a drawer with a safety latch, inaccessible to the children in care. LPAs observed the stove with stove knob covers. Applicant confirmed families provide meals and snacks. LPAs discussed the importance of having policies in place to ensure that all who help with care and supervision are aware of any dietary restrictions and/or allergies. LPAs also encouraged applicant to contact their local Resource and Referral agency, Connections for Children, to inquiry about any food programs and/or other professional development opportunities and resources. Under the sink cabinet was observed with a safety latch was observed, making the content inaccessible to the children in care. Kitchen is used as a walk way to access the home.

Next to the kitchen a small hallway leads to the rest of the home. Bedroom 2 has been designated as OFF LIMITS, door will remain closed and/or locked during the hours of operations.

An open face heater was observed next to the kitchen that needs to be barricaded. Open face heater in the living room was observed barricaded.

Next to bedroom 2, the bathroom that children use was inspected. Sink, toilet and bathtub were observed and inspected. All bathroom cabinets were observed with safety latches, making the content inaccessible to the children in care. LPAs reminded applicant that all toiletries in bathroom will need to remain inaccessible to the children in care during the hours of operations.

Next to bathroom, bedroom 1 was observed and inspected. Bedroom 1 has been designated as day care space. LPAs observed 3 pack and plays and one crib.

Living room was observed and inspected. LPAs observed a second pull station and working fire extinguisher. LPAs observed an adult size couch and 5 high chairs. Applicant confirmed children will eat in the living room space.

LPAs collected a signed LIC 855 confirming that children will nap in the living room and bedroom 1 and will eat in the primary residence and garage will only be used as additional activity space.

NAME OF LICENSING PROGRAM MANAGER: Maureen Neal
NAME OF LICENSING PROGRAM ANALYST: Judy Laureano
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025
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 RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MEDINA FAMILY CHILDCARE
FACILITY NUMBER: 197495298
VISIT DATE: 06/18/2025
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The outdoor space that children will use was observed and inspected. Children will use the back side yard of the home. LPAs observed age appropriate outdoor toys and a shaded areas. LPAs observed a chain link fence that leads the front yard. LPAs a requesting changing the lock on the gate per Fire Department instructions. The front yard was observed and inspected. The front yard was observed and inspected. A variety of outdoor toys were observed and inspected. Per Fire Department instructions, lock on the front picked fence will need to be replaced. LPAs reminded applicant that children need to be supervised at all times while playing in the front yard of the home.

Applicant confirmed the following areas are OFF LIMITS to the children in care: Main entrance of the home and bedroom 1. The kitchen is only used as a walkway. LPA reminded applicant that all areas designated as OFF LIMITS to the children in care need to remain close.

There are no firearms or ammunitions on the premises. All electrical outlets in the home were observed covered. LPA observed a working fire extinguisher in the kitchen area. A working fire alarm and carbon monoxide detector was observed in the space.

LPAs discussed Safe Sleep Regulations and resources with applicant. There is one crib or play yard for each infant in care, cribs and play yards are kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard. All cribs or play yards shall meet the United States Consumer Product Safety Commission safety standards. Infants are not swaddled while in care. Provider physically checks on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan will need to be completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping.

LPAs discussed and provided applicant the LIC 311D and a sample packet to use as a reference.

The following corrections will need to be complete by 6/25/2025
1. Replace the lock on the side chain link fence gate.
2. Replace the lock on the front picked fence.
3. Barricade the open face heater in next the kitchen.

Exit interview was conducted with applicant Beatriz Medina. The licensing determination of this application will be reviewed with Licensing Program Manager for final resolution.

NAME OF LICENSING PROGRAM MANAGER: Maureen Neal
NAME OF LICENSING PROGRAM ANALYST: Judy Laureano
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: MEDINA FAMILY CHILDCARE
FACILITY NUMBER: 197495298
VISIT DATE: 06/18/2025
NARRATIVE
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Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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 applicant has not obtained a signed Property Owner/Landlord Consent form (LIC9149). Without this consent, the applicant understands that, once licensed, they can operate with a maximum capacity of 6 [or 12] children. If property owner/landlord consent is obtained in the future, the applicant is advised that a new Application for a Family Child Care Home License (LIC 279) must be submitted with a change of capacity fee of $25, to increase the capacity and provide care to 8 [or 14] children. PIN 22-05-CCP Page Seven

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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) or (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 reviewed with [applicant, licensee, or facility representative] 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. Entrance Checklist was provided to the applicant. PIN 22-05-CCP Page Eight

LPA discussed the safe sleep regulations with [applicant, licensee, or facility representative] and 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 [applicant, licensee, or facility representative] 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.

Applicant was informed of the MyChildCarePlan.org site, 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.
NAME OF LICENSING PROGRAM MANAGER: Maureen Neal
NAME OF LICENSING PROGRAM ANALYST: Judy Laureano
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025
LIC809 (FAS) - (06/04)
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