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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198004419
Report Date: 03/19/2026
Date Signed: 03/19/2026 01:06:39 PM

Document Has Been Signed on 03/19/2026 01:06 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:PINEDA FAMILY CHILD CAREFACILITY NUMBER:
198004419
ADMINISTRATOR/
DIRECTOR:		PINEDA, ELVIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 562-7847
CITY:MAYWOODSTATE: CAZIP CODE:
90270
CAPACITY: 14TOTAL ENROLLED CHILDREN: 5CENSUS: 0DATE:
03/19/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:11 PM
MET WITH:Elvia PinedaTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On 03/19/26 at 12:11PM Licensing Program Analyst(LPA) J.Duran conducted an unannounced annual inspection at the above facility. LPA met with the Licensee Elvia Pineda and informed her of the purpose for the visit. LPA provided Licensee with a copy of the Facility Entrance Checklist. Licensee guided LPA on a tour of the facility. There were 0 child present during the inspection. Per licensee there are no infant children enrolled and currently school age children are enrolled. All residents were noted and verified. Also present was Staff 1- Licensee's spouse who is the Assistant. Facility is open Monday to Friday 6 AM to 6 PM.

This is a one story, 2 bedroom, 2 bathroom home, with a living room (daycare area), dining room, kitchen, back yard, detached garage with an additional dwelling unit (ADU) with one bedroom attached and a fenced front yard.

Per Licensee areas on limits to children are living room, dining room, hallway bathroom, kitchen and front yard. Per Licensee areas off limits to children are 2 bedrooms, entire back yard and detached garage including ADU.

All areas that are accessible to children were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection: LPA discussed required posted documentation with Licensee and advised the following shall be posted in a Licensed facility. Facility license, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPA observed licensing forms posted in the living room which is used as main care space. LPA observed a disaster drill log drill conducted 02/11/26. There is an operable carbon monoxide detector and a smoke detector in the facility. LPA observed a 2A10BC Fire Extinguisher in the facility which was serviced on 03/02/26. The home maintains telephone service (Land line and cell phone) LPA obtained new landline number from licensee. Food is provided by Licensee. Licensee was reminded if children bring food from home it must be labeled with the child’s name and properly stored or refrigerated.

Page 1 of 4. *****Inspection was conducted in Spanish*****

NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Javier Duran
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 02/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2026
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: PINEDA FAMILY CHILD CARE
FACILITY NUMBER: 198004419
VISIT DATE: 03/19/2026
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There are toys and other age appropriate materials available for children. Sharp objects, detergents and cleaning compounds were inaccessible to children in care. LPA observed knives on the kitchen counter in a locked container inaccessible to children in care. Cleaning products are kept in the cabinet under the kitchen sink with a safety latch making the cleaning compounds inaccessible to children. Per Licensee Children only have access to kitchen area to eat. LPA observed a small child size table and chairs in the kitchen area. During inspection LPA did not observe any items in the kitchen area that are hazardous or dangerous to children in care. There is an air conditioning unit in the living room. There is a wall heater in the living room which has a safety gate installed. Children use the restroom in the hallway. LPA observed cleaning products are contained in a latched cabinet under the sink.


Per Licensee the children currently use the front yard for outdoor play. LPA observed the front yard to have adequate shade with trees and a covered patio area, toys, furniture and equipment for children. The front yard is fenced and per Licensee, the children are supervised when they are outside at all times. LPA did not observe any items in the front yard that could pose a hazard or danger to children in care. Per Licensee, there are no poisons in the home. Licensee understands that all poisons must be locked, not only inaccessible to children. Isolation area for sick children waiting to be picked up is in the facility living room. Per Licensee, there are no firearms or weapons stored in the home. Per licensee there are no pools or bodies of water at the facility. LPA did not observe any fire arms or weapons, pools or spas, or other bodies of water during time of inspection.
At 2:10 Licensee stated she had to leave to pick up school age children and will return around 3:00 PM. Licensee assistant was able to continue annual inspection process with LPA.

Currently licensee has no infants enrolled. Licensee stated she does not want to provide care for infants at the moment. Licensee was reminded licensee if care is provided for infants the napping equipment should not block entrances or exits. Infant mattresses should be firm with tightly fitted sheets. LPA discussed that each infant enrolled must have their own crib/ napping mat and bedding. LPA informed licensee of LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months.


Page 2 of 4.
NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Javier Duran
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2026
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: PINEDA FAMILY CHILD CARE
FACILITY NUMBER: 198004419
VISIT DATE: 03/19/2026
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There is no overnight care provided at the moment. LPA discussed the following: Licensee is aware that they must remain awake while children are awake. If children sleep in separate area from licensee, the door must remain open. If licensee cannot hear children when they wake up, video or audio device can be used.


LPA observed 1 child file for Children's records (LIC) 282- Affidavit Regarding Liability Insurance, Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights. File was reviewed and complete. Licensee's and Staff 1's Pediatric CPR/First Aid expires 5/2026. Licensee and Staff 1 have proof of required immunizations (measles, pertussis, flu). LPA observed licensee & staff mandated reporter training certificate to be missing. Licensee Stated that she needs to print and email to LPA. One type B violation was issued, the licensee did not comply with the section cited above Licensee & Staff did not have Valid Mandated Reperter Certificate on file, which poses a potential health, safety or personal rights risk to persons in care.

Licensee Elvia Pineda was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee Elvia Pineda and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee Elvia Pineda of the importance of checking for and removing any 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.

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Javier Duran
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2026
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: PINEDA FAMILY CHILD CARE
FACILITY NUMBER: 198004419
VISIT DATE: 03/19/2026
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/

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

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

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Elvia Pineda.

NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Javier Duran
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/19/2026 01:06 PM - It Cannot Be Edited


Created By: Javier Duran On 03/19/2026 at 01:02 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: PINEDA FAMILY CHILD CARE
FACILITY NUMBER: 198004419

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/19/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
Plan of Correction
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Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Karen Chambers
NAME OF LICENSING PROGRAM MANAGER:
Javier Duran
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/19/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/19/2026


LIC809 (FAS) - (06/04)
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