198019013-9-26-2025-33-CC-VMGA-DLVQPK-20250926122051

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019013
Report Date: 09/26/2025
Date Signed: 09/26/2025 12:21:11 PM

Document Has Been Signed on 09/26/2025 12:21 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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	PEREZ FAMILY CHILD CARE		FACILITY NUMBER:	198019013
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 18	CENSUS: 7	DATE:	09/26/2025
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:15 AM
MET WITH:	Carina Perez		TIME VISIT/ INSPECTION COMPLETED:	12:35 PM

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This inspection was conducted in Spanish.

Licensing Program Analyst (LPA) Veronica Martinez Garza conducted an unannounced Annual/Required inspection at the above facility on 09/26/25 at 09:15am. The facility provides services to families in the military. According to the licensee, there are currently no military families enrolled at the facility. LPA met with Carina Perez licensee who guided LPA on a tour of the facility. There were 07 children present. Also present was the licensee’s assistant/daughter Diana Perez. Per licensee, 15 children are enrolled; however, upon review of the children’s roster, LPA observed 18 children are enrolled. Operation hours are Monday through Friday 06:00am – 06:00pm.

The purpose of the inspection is also for an increase in capacity. The licensee requested an increase in capacity from 8 to 14 on 07/18/25. Fire clearance was granted on 09/18/25.

This is a one-story home which consists of 3 bedrooms, 2 bathrooms, kitchen, living room, front yard, deck, backyard (fenced), laundry room, garage. Areas accessible to children include living room, 2 bedrooms, 1 bathroom, deck, and back yard. Per licensee, areas off limits to children and parents include 1 bedroom, 1 bathroom, kitchen, front yard, laundry room, and garage. According to the licensee, there is 1 dog on the premises. Family members residing in the home are 1 adult and 0 minors. All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing, or volunteering in a licensed home and are identified on the attached LIC 811.

LPA toured all areas identified on the facility sketch used by children during this visit and were inspected for safety, comfort, and cleanliness. Tour began in the living room where LPA observed furniture, age-appropriate toys, materials, and equipment for children.

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NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Veronica Martinez-Garza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2025

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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: PEREZ FAMILY CHILD CARE	FACILITY NUMBER: 198019013
	VISIT DATE: 09/26/2025

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Licensee then guided LPA to the kitchen which is an open floor layout. According to the licensee, the kitchen is off-limits to children. Licensee maintains cleaning products and knives in a top kitchen cabinet that was observed to be in accessible to children. LPA was then guided to the front bedroom which is adjacent to the living room. The bedroom does not have a door; however, licensee placed a well mounted child proof gate. LPA toured the bedroom and observed age-appropriate toys, materials, and equipment for children. There is a closet in the bedroom that is used to store materials or equipment for children. Licensee keeps the door closed with a child proof doorknob. LPA was then guided to the children’s bathroom which is located down the hallway from the living room. LPA observed the children’s bathroom is safe and in sanitary conditions. Per licensee, the bedroom at the end of the hallway is off-limits to children. Licensee then guided LPA to the bedroom near the entrance of the hallway which is used by children for activities or during nap time. LPA toured the bedroom and observed there were some materials, (1) play pen, and cots stored in the closet. The bedroom also has a bathroom; however, the licensee stated that the bathroom is off-limits to children. Play pen meets Title 22 regulations. The living room and children’s bedroom leads to the deck, backyard, and laundry room. LPA observed the deck has children’s furniture. The deck leads to the backyard and laundry room. Per licensee, children do not have access to the laundry room. The laundry room was observed to be inaccessible to children. There’s also a first aid kit readily available.

LPA observed the following required posted documentation in the entrance of the home: Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPA reviewed facility records LIC 610- Emergency Disaster Plan and Disaster drill log. All homes shall conduct fire and disaster drills at least once every six months and document the date and time of each drill. Last drill was conducted on 08/01/25. Children’s roster was available during this inspection.

Licensee does understand that licensing staff may have access to off-limit areas during inspection visit if necessary. **Rooms that are off-limits need to be made inaccessible during operating hours**

Per licensee, food is provided to children. Licensee was advised that if food is brought from the children’s homes, all containers must be labeled with the child’s name and properly stored or refrigerated. The facility has a working telephone, ventilation, and heating.

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NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Veronica Martinez-Garza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2025

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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: PEREZ FAMILY CHILD CARE	FACILITY NUMBER: 198019013
	VISIT DATE: 09/26/2025

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Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock. Per licensee, there are no firearms, weapons or bodies of water in the home.

At 09:31am smoke and carbon monoxide detectors were observed to be operable. The valve on the required 2A10BC fire extinguisher indicates fully charged and was purchased on 04/21/25, per the attached receipt. Per State Fire Marshall standards, fire extinguishers shall be serviced annually.

The isolation area for sick children waiting to be picked up is in the bedroom (nap/activities) with supervision.

Smoking is prohibited in a licensed Family Child Care Home. Per licensee, no one smokes in the home.

Children use the backyard for outdoor play. LPA observed the back yard has adequate shade, age-appropriate toys, and equipment. LPA did not observe any objects that could be hazardous to children in care. LPA advised the licensee to check with the American Standard Testing Materials for Playground Guidelines and/or to use the manufactures recommendations for the playground equipment in efforts to be more in line with safety guidelines. Licensee understands that children should be supervised at all times.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, and LIC 995A Notification of Parents’ Rights, LIC 9227- Infant sleep form (0-12 months, and documentation of 15-minute Infant Sleep Check (0-24 months). LPA observed that the parent’s of child 2 (C2) did not sign LIC 282. LPA provided a technical violation.

Staff records were reviewed for approved Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate. Licensee’s Mandated Reporter Training expires on 07/03/27 and Pediatric CPR/FA expires on 08/23/27.

AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018, any person who works in a child care facility shall complete the training and renew the training every 2 years. Website provided:https://www.mandatedreporterca.com/training/child-care-providers

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NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Veronica Martinez-Garza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2025

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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: PEREZ FAMILY CHILD CARE	FACILITY NUMBER: 198019013
	VISIT DATE: 09/26/2025

NARRATIVE

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Licensee does care for infants. 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-andresources/safe-sleep as an additional resource. LPA also informed licensee 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. No infant walkers, No baby bouncers, No Johnny jumpers, No exersaucers, and any other item that falls into that category.

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 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.

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.

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.

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NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Veronica Martinez-Garza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2025

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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: PEREZ FAMILY CHILD CARE	FACILITY NUMBER: 198019013
	VISIT DATE: 09/26/2025

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Licensee Carina Perez confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

During the inspection, LPA observed licensee had 7 children in care (1 infant and 6 preschoolers). Per licensee and assistant out of the 7 children present none are school age. LPA discussed, reviewed, and provided the licensee the capacity regulations sheet for a small family child care home license (Spanish). The capacity regulation sheet provides a breakdown of the number of children, including their age, that can be cared for when there are 7 or 8 children present. Due to the licensee being out of ratio of a small license, LPA will inquire with the supervisor as a possible meeting may be required before granting a large license.

The following deficiencies were cited in accordance with Title 22 of the California Code of Regulations and Health & Safety Codes. Please see 809D for documentation of deficiencies.

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

Exit interview conducted and report was reviewed with the licensee Carina Perez. Visit was conducted in Spanish and report was translated prior to obtaining signature.

Type A citation

LPA Veronica MartinezGarza informed licensee Carina Perez that this report dated 09/24/25 document(s) 1 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Veronica MartinezGarza informed the licensee Carina Perez to provide a copy of this licensing report dated 09/24/25 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

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NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Veronica Martinez-Garza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/26/2025 12:21 PM - It Cannot Be Edited

Created By: Veronica Martinez-Garza On 09/26/2025 at 11:48 AM

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: PEREZ FAMILY CHILD CARE	FACILITY NUMBER: 198019013
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/26/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102416.5(b)(3)

Staffing Ratio and Capacity

(b) For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following: (3) More than six and up to eight children, without an additional adult attendant, only if the criteria in Section 1597.44 of the Health and Safety Code are met. 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 in LPA observed 7 children in care (1 infant and 6 preschoolers) which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 10/03/2025
	Plan of Correction
1 2 3 4	Per licensee, she will readjust the children's schedule to ensure that she is in ratio. LIcensee will also submit a written declaration to LPA by POC due date.

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.

	Ana Chico
NAME OF LICENSING PROGRAM MANAGER:

	Veronica Martinez-Garza
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2025

LIC809 (FAS) - (06/04)

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