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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019687
Report Date: 09/12/2025
Date Signed: 09/12/2025 01:30:51 PM

Document Has Been Signed on 09/12/2025 01:30 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:
09/12/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH: Licensee Marisol AndrewsTIME VISIT/
INSPECTION COMPLETED:
01:37 PM
NARRATIVE
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Licensing Program Analyst (LPA) Ashley Calderon conducted an unannounced Case Management Annual Continuation inspection at the above facility. LPA met with Licensee Marisol Andrews who allowed LPA entrance at 9:55am into the facility. LPA disclosed purpose of today's visit.

LPA Calderon upon entrance observed 8 children, one was an infant. LPA observed Infant resting on their back in the play yard. Play Yard was observed with a firm mattress and fitted sheet, play yard was observed with no loose items. Facility is Licensed for Large Family Child Care Home- Capacity 14. On today's date, facility had 8 children present and no assistant present therefore was observed to comply in capacity of a Small FCC.

On 9/11/25 LPA Calderon contacted Licensee Marisol Andrews and asked about live scan update status. Per M.Andrews informed LPA Calderon went to UPS store to get live scan form and they didn't have live scan form. On today's date Licensee M.Andrews informed LPA at 10:10am they went to UPS store to get live scan for their Adult Son living in the home and they told Licensee system was down to do fingerprints. At 11:05am Licensee provided copy of Live Scan form to LPA Calderon, LPA took a picture of form and observed form is incomplete #8 Live Scan Transaction Completed By section was observed left blank, deficiency cited and civil penalty given.

LPA Calderon observed wine bottles placed in cabinet above the refrigerator. LPA observed laundry/storage room with a changed door knob that now locks, door knob lock was placed to ensure inaccessibility to detergents, chemicals and cleaning components. (Cont...)
NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 6
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: 09/12/2025
NARRATIVE
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On 8/20/25 LPA observed required 2A10BC fire extinguisher that was last serviced on 07/22/24, being cited on today's date even though fire extinguisher was serviced for 8/21/25 due to sevice date from 8/202/25 visit. Children's files were reviewed. files had LIC9224 Acknowledgment of Receipt of Licensing Reports for visit issued on 8/20/25. Children files observed to have Affidavit Regarding Liability Insurance, used as a back up. On 8/20/25 LPA reviewed Liability Insurance Bond for day care. On 8/20/25 Child #1 and Child #2 whom are infants, LPA observed their 15 min sleep log, log indicates time start of sleep and end time, does not show each 15 min time that children were checked, deficiency cited on today's visit. Per record review, Child #1 is in the age range between 0 months- 12 months, on 8/20/25 LPA observed no Individual Infant Safe Sleep Plan -LIC 9227 in child's file, Per Licensee Child #1 last day is today on 9/12/25, consolation given. LPA reviewed 6 children files. LPA reviewed staff files. Per Licensee, adult son and daughter volunteers at the facility. LPA Calderon informed Licensee volunteers should not exceed 16 hours a week and their files need their immunization records. Per Licensee, Husband assistant occasionally. During record review, at 11:01am LPA took pictures of Licensee and Adult Son's Pediatric 1st aid and cpr certificate issued by National CPR Foundation, LPA observed no EMSA Stickers and certificate is not valid per Title 22 requirements and Licensee was unable to provide Pediatric 1st aid and cpr for staff assistant , deficiency cited. LPA reviewed Licensee Mandated Reported (M.R) Certificate Expires 11/10/2025 and Licensee is unable to provide Staff Assistants M.R certification, deficiency cited. LPA Calderon conducted a staff interview with Licensee.

LPA observed outside area, outside area children use does not have a fence. Therefore, Per Licensee,uses drive way/ drive way grass area, cars in the drive way are parked on the streets when children play outside and Licensee supervises children when outside at all times. Per Licensee, occasionally uses local park located in front of the home, Stevenson Park and home was observed with no bodies of water.

Based on today’s visit, Per California Code of Regulations Title 22, the facility was given (1) deficiencies, Type A with a Repeated Violation Civil Penalty and (4) deficiency Type B's. Civil Penalty was given for adult 18 and over not fingerprinted cleared and POC from 8/20/25 was not cleared.LPA Ashley Calderon informed licensee Marisol Andrews that this report dated 9/12/25 document(s) (1) Type A citationa 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 9/13/25 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 and a Notice of Site visit was given must remain posted for 30 days.
NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2025
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 09/12/2025 01:30 PM - It Cannot Be Edited


Created By: Ashley Calderon On 09/12/2025 at 11:38 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ANDREWS FAMILY CHILD CARE
FACILITY NUMBER: 198019687

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/12/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
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: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation on 8/20/25 fire extinguisher service tag dated on 07/22/24 , the licensee did not comply with the section cited above in [1] out of [1] fire extinguisher not comply State Fire Marshall regulations which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/12/2025
Plan of Correction
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Fire extinguisher Service tag observed on 9/12/25 dated Aug 21, 2025. POC cleared on today's date.
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 record review LPA Calderon, the licensee did not comply with the section cited above in [1] out of [1] staff did not have Mandated Reporter Certfication which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/19/2025
Plan of Correction
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Licensee Husband staff assistant will conduct training online for Mandated Reporter and will send a copy to LPA Calderon.
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: 09/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2025


LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 09/12/2025 01:30 PM - It Cannot Be Edited


Created By: Ashley Calderon On 09/12/2025 at 11:38 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ANDREWS FAMILY CHILD CARE
FACILITY NUMBER: 198019687

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/12/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review Licensee Pediatric 1st aid and cpr certificate issued by National CPR Foundation certficfate observed with no EMSA Stickers and certificate staff assistant did not have a CPR/1st aid certificate, the licensee did not comply with the section cited above in [2] out of [2] staff did not have a valid Pediatric 1st aid and cpr certficate which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/19/2025
Plan of Correction
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Licensee and Staff Assistant (Licensee's husband) will obtain a valid Pediatric 1st aid / cpr certficiate and submit to LPA Calderon by poc due date.
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review on 8/20/25 Child #1 and Child #2 15 min sleep log showed start of sleep time and end of sleep time, it was observed not to show time of 15 min checks, the licensee did not comply with the section cited above in [2] out of [2] incomplete (2) infant records which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/19/2025
Plan of Correction
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Licensee will submit for Child #2, 15 min sleep log showing 15 min time frame to LPA Calderon by poc due date.
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: 09/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/12/2025 01:30 PM - It Cannot Be Edited


Created By: Ashley Calderon On 09/12/2025 at 12:21 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: 09/12/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
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 9/11/25 interview via telephone with Licensee Marisol Andrews informed LPA Calderon UPS did not have livescan form and on visit date 9/12/25 based on record review Live Scan form was provided to LPA Calderon Section #8 Live Scan Transaction Completed By observed blank, Per Licensee Marisol Andrews went on 9/11/25 to UPS office and they stated fingerprinted system is down. On 8/20/25 facility was cited for a resident who was not fingerprinted cleared, poc was to do livescan form and submit form to LPA Calderon by 8/21/25 live scan not submitted and observed incomplete on 9/12/25 the licensee did not comply with the section cited above in [1] out of [1] non fingerprint cleared adult resident living in the home which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/13/2025
Plan of Correction
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Licensee will get Adult Son live scanned, Per Licensee will attempt to go to several UPS stores to get Adult Son fingerprinted, LPA Calderon provided number of live scan reservation 1-800-315-4507 and Licensee will submit Live Scan form 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: 09/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2025


LIC809 (FAS) - (06/04)
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