198006610-11-24-2025-54-CC-ACAN-DNQSJ9-20251124125447

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198006610
Report Date: 10/27/2025
Date Signed: 11/24/2025 12:55:04 PM

Document Has Been Signed on 11/24/2025 12:55 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:	BUTLER FAMILY DAY CARE		FACILITY NUMBER:	198006610
ADMINISTRATOR/ DIRECTOR:	BUTLER, PATRICIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 223-3132
CITY:	CARSON	STATE: CA	ZIP CODE:	90746
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	10/27/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:47 AM
MET WITH:	Licensee Patricia Butler		TIME VISIT/ INSPECTION COMPLETED:	01:10 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	Licensing Program Analyst (LPA) Ashley Calderon conducted an unannounced random/annual inspection to the above facility. LPA met with Licensee Patricia Butler who allowed entrance into the facility, and discussed the purpose of today's visit. Per Licensee, due to the holidays is closed and no children will be coming today. During visit 0 children were present. The home is licensed for a Large Family Child with a Capacity of 14. The facility Hours of Operation: Monday to Friday 6am to 6pm. Licensee states that sometimes hours extended based on parents needs or if weekends are needed. Licensee cares for children ages infants - 17 years old. This is a two story home which consists of 6 bedrooms, 3 bathrooms, kitchen, living room, family room, garage and backyard (fenced). The children use the family room, garage (No napping or feeding takes place in the garage), restroom in the hallway which the children use, one bedroom, kitchen and front yard. Off limits to children and parents include: living room, (1) downstairs bedroom, all upstairs, 2 bathrooms, backyard (with pool). Off limit areas are inaccessible by key lock knobs. Required postages: Parent Rights, Earthquake Preparedness and Facility License posted in garage area. When children under 5 years old are present, licensee will place a baby safety gate at the bottom of the stairs to have the upstairs off-limit area/rooms inaccessible to children. Cleaning components and poisons remain locked in locked storage cabinet located in the garage. Sharps are placed in inaccessible area in laundry room/ storage located in the garage, locked door knob in place when children are present. Children who are ill waiting to be picked up will use the on limit bedroom or the garage; whichever is available and not in use by children who aren't sick. Food is provided for day care children by the Licensee. Fire place was observed in family room secured/barricaded. Disaster and Fire Drill was conducted on 10/03/2025. Fire extinguisher got serviced with a service date of 4/21/25. Smoke and Carbon monoxide detector tested and operable. Facility has current LIC9040 Child Care Facility Roster, reviewed during visit.

NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2025

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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: BUTLER FAMILY DAY CARE	FACILITY NUMBER: 198006610
	VISIT DATE: 10/27/2025

NARRATIVE

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The room near the bathroom has one crib for infants in care, currently no infants in care; observed with a firm mattress and fitted sheets. The home has central heating and ventilation (A/C) system throughout the house. Home has age appropriate toys, materials and equipment for children in care.

LPA Calderon observed the back yard which is off limits to the children in care, which has a pool; upon existing to the back yard the home has a alarm on the door for additional safety measures. There is a mesh fence around the pool, the door swings away from the swimming pool, the door self latches, and there is a key lockable device that is placed at the height of 60 inches. No gaps or voids that can allow the passage of a sphere with a diameter equal to or greater than four inches observed , during visit LPA measured gaps / voids along the fence, (2) gaps/voids by the walls measured at 3 inches, the remaining measured at 1-2 inches. The vertical clearance are less than 1 inches along the pool and at the door the vertical clearance was measured and measures at 2 inches which meets the requirement of: a maximum vertical clearance of two inches from the ground to the bottom of the enclosure. LPA observed a life ring, picture taken, life ring was measured with an exterior diameter of 20 inches (above the requirement of 17 inches) and documentation was shown indicating the device is approved by the United States Coast Guard. Although no label on the life ring, documentation was provided. LPA observed a Pool Record log with a daily inspection conducted by the facility, consultation was given to indicate safety measures that apply to the facility pool - ex: checking alarm is on, pool gate is locked, life ring in place, pool hook in place and mesh fence in good condition.LPA observed (2) rescue poles with a body hook and a minimum fixed length of 12 feet, both met requirements. LPA Calderon observed a functioning pool alarm; alarm is compliant with ASTM International Standard F2208, documentation of proof provided.

LPA reviewed Liability Insurance Documentation by Acord / Producer: Next First Insurance Co expires 11/10/2026, facility has over the required liability amount bond. Health and safety requires:liability insurance covering injury to clients and guests in the amount of at least one hundred thousand dollars ($ 100,000) per occurrence and three hundred thousand dollars ($ 300,000) in the total annual aggregate. Licensee has Pediatric first aid and cpr by American Red Cross expires 4/2/2027. Mandated Reporter certificate expires 11/28/2025. Staff assistants record was reviewed who is qualified with pediatric first aid and cpr and active mandated reporter. LPA reviewed (5) children files, LPA consulted on LIC9150 Additional Children in Care form, and having licensing forms if they do not have the same information on Resource and Referral Agency forms. LIC126 Entrance checklist was provided.

NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/24/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2025

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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: BUTLER FAMILY DAY CARE	FACILITY NUMBER: 198006610
	VISIT DATE: 10/27/2025

NARRATIVE

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Licensee 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 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 licensee 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.
This facility currently does not provide Incidental Medical Services – IMS. . For IMS information see PIN 22-02-CCP. 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 are available at: https://www.ada.gov/resources/child-care-centers/.
Licensee 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 Patricia Butler , confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.
To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Per California Code of Regulation, Title 22, facility was given no deficiencies during today's visit and were found to be in compliance.

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

Exit interview conducted and report was reviewed with the licensee Patricia Butler.

NAME OF LICENSING PROGRAM MANAGER: Warren Birks
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/24/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2025

LIC809 (FAS) - (06/04)

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