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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019687
Report Date: 08/20/2025
Date Signed: 08/20/2025 05:34:14 PM

Document Has Been Signed on 08/20/2025 05:34 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:ANDREWS FAMILY CHILD CAREFACILITY NUMBER:
198019687
ADMINISTRATOR/
DIRECTOR:		MARISOL ANDREWSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 951-0157
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
08/20/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:08 PM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
05:38 PM
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Licensing Program Analyst (LPA) Ashley Calderon conducted an unannounced random annual inspection at the above facility. LPA met with Licensee Marisol Andrews who allowed LPA entrance into the facility. LPA disclosed purpose of today's visit.

LPA upon arrival observed Licensee , staff assistant (Per Licensee daughter) , adult son (per assistant does assist with the day care), (9) children (2 which were infants). Per Licensee, staff assistant is not 18 year old, LPA informed Licensee cannot stay alone with children.

LPA was guided analysts on a tour of the facility alongside Licensee M.Andrews. Hours of operation are Mon-Fri 6:00 AM - 5:30PM.

This is two story home which consists of four bedrooms, two full bathrooms, one half bath, living room, kitchen, dining area, front yard, garage/ activity room, and backyard.
On limit: living room, dining area, and garage/activity room, one bathroom, front yard.
Off limits: all of upstairs (gated observed), two bathrooms and backyard.

At 2:23pm LPA Calderon asked for son name. Per Licensee, son name was disclosed to LPA Calderon, LPA asked for their age, Licensee stated son is 19 years old. LPA informed Licensee that son is not on the facility roster. LPA asked Licensee was son fingerprinted cleared when he turned 18 years old, Licensee no not yet. Licensee informed Licensee son does not assist with the day care. Per Licensee, son still lives at home, deficiency cited with civil penalties assessed. Son was observed to leave home at appox 2:20pm. Individuals residing in the home have been discussed and noted. (Pg 1/ cont.)
NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/20/2025
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: ANDREWS FAMILY CHILD CARE
FACILITY NUMBER: 198019687
VISIT DATE: 08/20/2025
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All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection: LPA reviewed required posted documentation's located in living room for: Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form (LIC9148 printed and posted during visit). Facility records were reviewed for LIC 9040- Facility Roster (needs to be updated with dates children left and no longer enrolled at the day care, consultation ), Fire/ Disaster drill log, last drill conducted on 08/2025. LPA observed required 2A10BC fire extinguisher that was serviced 07/22/24, deficiency type B will be cited at another time. LPA Calderon reviewed Liability Insurance from Acord/ Markel Service Co- expires 1/7/26, required liability bond was reviewed on.

The home maintains telephone service via cell phone. During today's visit smoke and carbon monoxide was tested.

Per Licensee, provides meals and snacks to children in care. Knives were observed in kitchen counter were children present can not reach. LPA informed Licensee to assess the situation, if older children present they may reach knives were they are currently located and to make sure it is inaccessible for all ages when present at the facility. Per Licensee, Chemicals, cleaning compounds and solutions are stored in laundry area, laundry room has a door knob that cannot be locked, observed by LPA Calderon at 2:54pm, picture taken. At 2:54pm Licensee opened laundry room LPA observed on the floor Clorox bleach, on low shelves propane tanks (2), shelves above laundry machines are high to reach had cleaning compounds and solutions, detergents observed on laundry machine, in the shelve LPA observed Raid Ant and Roach killer poison in a white bottle spray bottle, picture taken. During visit Licensee, threw Raid poison in the outside City Trash can and informed Licensee they have a pest control company who comes to the home; in addition LPA Calderon at 3:10pm LPA observed wine bottles (15 count) in the wine rack located under wine cabinet bar, low to the ground, accessible to children in care, deficiency Type B cited. Wine bottles during visit were placed in off limit bedroom upstairs inaccessible to children. Per Licensee, adult supervises child when in the restroom that is next to the laundry room, laundry room has a baby gate in front of the door.

Per Licensee, does not provide transportation. Per Licensee, has 2 pet dogs in the home, during visit one was observed to be around the children and one was in off limit to children in dog gate Per Licensee, no children are administered medication at the facility. Per Licensee no guns in the home.
(Pg 2 /cont..)
NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2025
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: ANDREWS FAMILY CHILD CARE
FACILITY NUMBER: 198019687
VISIT DATE: 08/20/2025
NARRATIVE
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Children play in the front yard and per Licensee go across street to Stevenson Park. Per Licensee, children are fully supervised when they are outside. Front yard and inside observed to have age appropriate toys and no bodies of water observed on premises.

Per Licensee, Isolation area for sick children waiting to be picked up is in the living room, away from the other children.

LPA reviewed Child #1 and Child #2 infants 15 min sleep log indicates time start of sleep and end time, does not show each 15 min time that children were checked deficiency type B will be cited at another time. and Child #1 is in the age range of 0-12 months, Infant does not have Lic9227 Individual sleep plan, deficiency type B will be cited at another time.



Infants present Child #1 and Child #2 per Licensee uses the same play pen and sleeps in play pen. LPA observed two play pens, one stored in closet. LPA informed Licensee infants must sleep in play yard or crib and have availability for each infant present at one time with firm mattress and fitted sheets for each play yard or crib, deficiency type A cited. LPA informed Licensee play pens are not to be used for sleeping purpose, only for play.

LPA suggested Technical Support Program (TSP) and discussed program- per Licensee will like to enroll in program and LPA will submit application to TSP Coordinator.
  • 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.

(Pg 3/ cont)
NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2025
LIC809 (FAS) - (06/04)
Page: 6 of 7
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: ANDREWS FAMILY CHILD CARE
FACILITY NUMBER: 198019687
VISIT DATE: 08/20/2025
NARRATIVE
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  • 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 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.
  • 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 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, 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 must remain posted for 30 days.

Based on today’s visit, Per California Code of Regulations Title 22, the facility was given (2) deficiencies, Type A and (1) deficiency Type B . Civil Penalty was given for adult 18 and over not fingerprinted cleared.
LPA Ashley Calderon informed licensee Marisol Andrews that this report dated 8/20/25 document(s) (2) Type A citations which shall be posted for 30 consecutive days as there is/are immediate risk to the health, safety, or personal rights of children in care.Also, LPA Calderon informed the licensee to provide a copy of this licensing report dated 8/20/25 that documents any Type A citations 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.
An exit interview was conducted with Licensee Marisol Andrews. Technical issues started at 5:19am. (Pg 4/ End of report)
NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2025
LIC809 (FAS) - (06/04)
Page: 7 of 7
Document Has Been Signed on 08/20/2025 05:34 PM - It Cannot Be Edited


Created By: Ashley Calderon On 08/20/2025 at 04:04 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: ANDREWS FAMILY CHILD CARE
FACILITY NUMBER: 198019687

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/20/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102352(p)(2)
Definitions
(2) "Play Yard" means a framed enclosure with integrated mesh or fabric sides that has not been banned or recalled by the United States Consumer Product Safety Commission.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview per Licensee M.Andrews uses the same play pen and sleeps in play pen for infants. LPA observed two play pens and not play yards or cribs with firm mattress and fitted sheets , the licensee did not comply with the section cited above in [2] out of [2] infant sleeping equipment which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/21/2025
Plan of Correction
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Licensee will send pictures of purchased play yards or cribs with firm mattress and fitted sheets by poc due date.
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview with Licensee M.Andrews informed LPA son is 19 years old.LPA asked Licensee was son fingerprinted cleared when he turned 18 years old, Licensee no not yet, son still lives at home, the licensee did not comply with the section cited above in [1] out of [1] adult not fingerprinted cleared which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/21/2025
Plan of Correction
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Licensee will set up appoitnment for Live scan, appointment for TB (current) with MD, LIC279 application and Lic289B current children living in the home updated and sent to LPA Calderon and to the department by poc due date. Once live scan is processed and clearance letter is received, Licensee will submit forms to LPA Calderon via email.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Denise Gibbs
NAME OF LICENSING PROGRAM MANAGER:
Ashley Calderon
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/20/2025


LIC809 (FAS) - (06/04)
Page: 4 of 7
Document Has Been Signed on 08/20/2025 05:34 PM - It Cannot Be Edited


Created By: Ashley Calderon On 08/20/2025 at 04:04 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: ANDREWS FAMILY CHILD CARE
FACILITY NUMBER: 198019687

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/20/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
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: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation wine bottles on wine bar low to ground in kitchen, and low detergants in laundry room has baby gate and door knob has no lock, and poison in high shelve above laundry machines, poison thrown away in city trash can outside of home, the licensee did not comply with the section cited above in [1] out of [3] [(objects) items which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/22/2025
Plan of Correction
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Lock o laundry room door, wines duirng visit moved to off limit upstairs area, will send picture of lock and new area where wines will be stored to LPA Calderon by poc due date.
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.
Denise Gibbs
NAME OF LICENSING PROGRAM MANAGER:
Ashley Calderon
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/20/2025


LIC809 (FAS) - (06/04)
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