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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019920
Report Date: 07/30/2025
Date Signed: 07/30/2025 05:09:38 PM

Document Has Been Signed on 07/30/2025 05:09 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:MASON FAMILY CHILD CAREFACILITY NUMBER:
198019920
ADMINISTRATOR/
DIRECTOR:		JODI MASONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 298-9984
CITY:PASADENASTATE: CAZIP CODE:
91107
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
07/30/2025
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Licensee Jodi MasonTIME VISIT/
INSPECTION COMPLETED:
05:45 PM
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On 07/30/25 at 2:30pm, Licensing Program Analyst (LPA) Stephanie Li conducted an unannounced annual inspection to the above facility. A risk assessment was conducted upon entry. LPA met with Licensee Jodi Mason, who led LPA on a tour of the facility. There were 9 children and 3 adults present upon arrival. Per Licensee, there is currently 12 children enrolled. A current children’s roster was available for review.

This is a one-story home which consists of 3 bedrooms, 3 bathrooms, kitchen, dining room, dining nook, living room, daycare (family room), driveway (fenced) where children play, garage, and backyard (with fenced pool). The children use the family room, dining room, dining nook, kitchen, family room (daycare room) and backyard and driveway. Per licensee, areas off limits to children and parents include: 3 bedrooms, 2 bathrooms, and garage. The LPA toured all areas used by children during this visit. Hours of operation are Monday-Friday 5:00am-4:00am. Licensee is with Options food program.

LPA observed all off limits areas were inaccessible during operating hours. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. Licensee has a firearm stored accordingly to Title 22 regulations in the off limits area of the home.

The following was observed and reviewed during this inspection. Cleaning compounds, and medications were observed to be inaccessible to children. Per licensee, there are no poisons kept in the home. The restroom that children use was observed to be safe and sanitary.

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NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Stephanie Li
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2025
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 8
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: MASON FAMILY CHILD CARE
FACILITY NUMBER: 198019920
VISIT DATE: 07/30/2025
NARRATIVE
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There is telephone service via landline and cellphone that stays at the facility during operation hours. The home is observed to be clean and orderly with central ac unit and heat. There are toys and other age appropriate materials available for children. Licensee has cots and play pens for napping children. Licensee cares for infants and play pens were observed for napping infants. There are first aid supplies available.

LPA observed the following required posted documentation in the main entry way of the facility: Facility License, Publication (PUB) 394- Notification of Parent Rights, (LIC) 9148- Earthquake Preparedness form, and Care seat PUB. LPA reviewed facility records for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Log was observed on parent board, last drill conducted 7/2025.


LPA observed a the required 2A 10 BC fire extinguisher, last purchased 7/17/25 as indicated on service tag. LPA reminded licensee that fire extinguisher needs to be serviced every year or purchased every year and retain the receipt. Smoke and carbon monoxide detectors were tested and are operable. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.



Currently, children are using the driveway for outdoor play time. The outdoor play area was observed to be fenced. LPA observed the outdoor yard to have appropriate toys and other materials for children to use. LPA did observe an in-ground gated pool in the backyard. LPA checked latch gate and gate does not swing close and self latch. LPA did not observe a US Coast Guard approved life ring nor the required 12 ft rescue pole and hook. Per licensee, she was not aware of the new pool regulations for 2025. LPA did not observe a sensor in- pool alarm or pool cover. Deficiencies are being issued per AB 2866 California legislative regulations. See page LIC809-D. AB 2866 Pool safety regulations were printed and provided to licensee. Per licensee, she has a pool guy she will contact to assist with correcting pool deficiencies. Per licensee, they have a summer swim program and take children out to the pool on Wednesday and Friday. Per licensee, all children are required to wear floating life jackets while in the pool. LPA also advised that Water Safety Certificate needs to be obtained from American Red Cross for adults supervising children while swimming.
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NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Stephanie Li
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2025
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: MASON FAMILY CHILD CARE
FACILITY NUMBER: 198019920
VISIT DATE: 07/30/2025
NARRATIVE
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Children and adult records were available to review. Licensee and assistant have CPR/First aid exp 8/2025. Per licensee, Mandated Reporter AB 1207 Training Certificate has not been renewed for all adults. exp 8/2024. A deficiency is being issued, see page lic809D.


Licensee stated IMS is not being provided at this time. 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/.

LPA discussed the safe sleep regulations and discussed the Child Care Licensing Safe Sleep webpage at http://www.cdss.ca.gov/inforescources/child-care-licensing/public-information-and-resoucrces/safe-sleep as an additional resource. LPA also informed applicant/licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at http://www/cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. Safe sleep regulations were reviewed with licensee. LIC9227 infant form was reviewed for future infant enrollment.

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.

Megan’s Law - Family Child Care Homes During the exit interview, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

LPA advised the licensee to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov



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NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Stephanie Li
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2025
LIC809 (FAS) - (06/04)
Page: 4 of 8
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: MASON FAMILY CHILD CARE
FACILITY NUMBER: 198019920
VISIT DATE: 07/30/2025
NARRATIVE
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MyChildCarePlan.org – Centers and Family Child Care Homes 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

Based on Licensing staff observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health and safety.

Licensing staff informed licensee a copy of this licensing report dated 07/30/2025 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.



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

Exit interview conducted, report, and appeal rights were reviewed with Licensee Jodi Mason.



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NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Stephanie Li
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2025
LIC809 (FAS) - (06/04)
Page: 5 of 8
Document Has Been Signed on 07/30/2025 05:09 PM - It Cannot Be Edited


Created By: Stephanie Li On 07/30/2025 at 04:26 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MASON FAMILY CHILD CARE
FACILITY NUMBER: 198019920

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/30/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.814(a)(1)(A)(i)
Pool Safety
(a) A licensed family daycare home operated at a private single-family dwelling with an in-ground swimming pool on the premises shall comply with all of the following requirements: (1) The swimming pool shall be equipped with, at minimum, the following drowning prevention safety features: (A) An enclosure, including, but not limited to, a fence, wall, or other barrier that isolates the swimming pool from access to the family daycare home and has all of the following characteristics: (i) An access gate that opens away from the swimming pool and is self-closing with a self-latching, key lockable device placed no lower than 60 inches above the ground.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in pool gate does not self close and self latch, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/29/2025
Plan of Correction
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Per licensee, she will contact her pool guy to assist with repairing her pool gate to self close and self-latch. Licensee will contact LPA to update status of corrections.
Type A
Section Cited
HSC
1596.814(a)(1)(B)
Pool Safety
(a) A licensed family daycare home operated at a private single-family dwelling with an in-ground swimming pool on the premises shall comply with all of the following requirements: (1) The swimming pool shall be equipped with, at minimum, the following drowning prevention safety features: (B) In addition to the characteristics described in subparagraph (A), at least one of the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in pool does not have pool cover or in pool sensor alarm, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/29/2025
Plan of Correction
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Per licensee, she will contact her pool guy to asees and assist with installing a pool cover or in-pool sensor alarm. Licensee will contact LPA to update status of correction completion 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.
Christina Gabelman
NAME OF LICENSING PROGRAM MANAGER:
Stephanie Li
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/30/2025


LIC809 (FAS) - (06/04)
Page: 6 of 8
Document Has Been Signed on 07/30/2025 05:09 PM - It Cannot Be Edited


Created By: Stephanie Li On 07/30/2025 at 04:26 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MASON FAMILY CHILD CARE
FACILITY NUMBER: 198019920

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/30/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.814(a)(2)(A)
Pool Safety
(a) A licensed family daycare home operated at a private single-family dwelling with an in-ground swimming pool on the premises shall comply with all of the following requirements: (2) The licensee shall have the following safety equipment visible from the swimming pool and readily available for immediate use: (A) A life ring with a minimum exterior diameter of 17 inches and labeled as approved by the United States Coast Guard.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in licensee does not have life ring near pool, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/13/2025
Plan of Correction
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Per licensee, she will contact pool guy to help her obtained required life ring and send a photo of installed life ring to LPA's phone by 8/13/25.
Type A
Section Cited
HSC
1596.814(a)(2)(B)
Pool Safety
(a) A licensed family daycare home operated at a private single-family dwelling with an in-ground swimming pool on the premises shall comply with all of the following requirements: (2) The licensee shall have the following safety equipment visible from the swimming pool and readily available for immediate use: (B) A rescue pole with a body hook and a minimum fixed length of 12 feet.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in licensee does not have 12 foot rescue pole with body hook readily available near pool, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/13/2025
Plan of Correction
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Per licensee, she will contact pool guy to help her obtained required life ring and send a photo of installed life ring to LPA's phone by 8/13/25.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Christina Gabelman
NAME OF LICENSING PROGRAM MANAGER:
Stephanie Li
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/30/2025


LIC809 (FAS) - (06/04)
Page: 7 of 8
Document Has Been Signed on 07/30/2025 05:09 PM - It Cannot Be Edited


Created By: Stephanie Li On 07/30/2025 at 04:26 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MASON FAMILY CHILD CARE
FACILITY NUMBER: 198019920

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/30/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.814(a)(3)
Pool Safety
(a) A licensed family daycare home operated at a private single-family dwelling with an in-ground swimming pool on the premises shall comply with all of the following requirements: (3) A licensee shall perform a daily inspection of the drowning prevention safety features and safety equipment before opening the facility and maintain a log of the inspections to be provided to the department upon request.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in daily inspection of pool safety features are not checked daily and logged, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/31/2025
Plan of Correction
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Per licensee, she will begin conducting daily inpsections of pool safety features and keeping a log. Licensee will take picture of log and send to LPA S Li phone by 7/31/25.
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, the licensee did not comply with the section cited above in mandated reporter training has not been renewed, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/20/2025
Plan of Correction
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Per licensee, she will have all adults complete updated mandated reporter training by 8/20/25 and send certificates to LPA S Li phone by 8/20/25.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Christina Gabelman
NAME OF LICENSING PROGRAM MANAGER:
Stephanie Li
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/30/2025


LIC809 (FAS) - (06/04)
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