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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020044
Report Date: 09/17/2025
Date Signed: 09/17/2025 04:20:01 PM

Document Has Been Signed on 09/17/2025 04:20 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:ALVAREZ LEIVA FAMILY CHILD CAREFACILITY NUMBER:
198020044
ADMINISTRATOR/
DIRECTOR:		ALVAREZ LEIVA,S & CARLOSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 448-4169
CITY:DOWNEYSTATE: CAZIP CODE:
90240
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
09/17/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:08 PM
MET WITH:ALVAREZ LEIVA Licensee TIME VISIT/
INSPECTION COMPLETED:
04:32 PM
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On 9/17/25 Licensing Program Analysts (LPA) Tyler Reyes conducted an unannounced Case Management - Annual Continuation inspection at the above facility. LPA met with Licensee Siomara. LPA observed (8) children in care. Per Licensee hours of operation are Monday-Saturday from 6am- 6am. LPA discussed with Licensee that “Overnight Care” means care being provided to children anytime between the hours of 6pm and 6am. Care provided during the day and overnight combined shall not exceed 24 hours from the time the child entered care. The facility is licensed to care for MAX. CAP(WHEN THERE IS AN ASSISTANT PRESENT): 12 - NO MORE THAN 4 INFANTS. CAP 14 - NO MORE THAN 3 INFANTS. 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6. LPA discussed and provided copies of Capacity Regulations for Family Child Care Home License, Personnel Report LIC 500, and Child Care Facility Roster LIC 9040.

During the inspection, the following individuals were present in the home: Licensee Siomara, Carlos and Staff 1 (S1). All adults present in the home have obtained a criminal record clearance or exemption. LPA informed that any individual that has direct contact with the children and resides in the home is required to have a criminal record clearance or exemption.

Facility Postings: LPA observed required postings in entrance: Facility Licensee, PUB 394 Notification of Parents’ Rights, and LIC 9148 Earthquake Preparedness, and LIC 610A Emergency Disaster Plan. LPA discussed the documents to be posted in a prominent, publicly accessible area at facility. LPA provided an updated copy of PUB 394 and LIC 9148.

Emergency Disaster Drill: Fire/Earthquake Drill conducted 8/8/25

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Tyler Reyes
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/17/2025
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: ALVAREZ LEIVA FAMILY CHILD CARE
FACILITY NUMBER: 198020044
VISIT DATE: 09/17/2025
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Pediatric CPR/First Aid in Pediatrics Certification: Licensee Siomara Completed 7/9/24 and Valid 07/26 from American Heart Association and S1 Completed 2/21/25 and Valid 02/27 from American Heart Association.

Mandated Reporter Training Certificate: Based on record review Licensee Siomara and Carlos do not have a current Mandated Reporter Training Certificate which poses a potential health and safety risk. S1 Completed Mandated Reporter Training Certificate 4/11/25.

LPA observed a fire extinguisher in the day care room with an expired service tag August 7,2024 which poses a potential health and safety risk. Family Child Care Homes are required to maintain a new or serviced fully charged fire extinguisher which is at least a 2A:10BC annually. LPA observed an operable smoke and carbon monoxide detector. LPA observed multiple electrical outlets within the facility uncovered and unsecured which poses a potential health and safety risk. LPA reminded the licensee to ensure that all unused electrical outlets always remain covered.

Infants: Per Licensee no infants currently enrolled. LPA discussed infant safe sleep with Licensee. Facility should supervise infants while they are sleeping adhering to physical checks every (15-minute) and ensuring infants are sleeping on their back. Documentation of these checks shall be maintained in the infant’s file and made available for Department review. Documentation shall include the date, infant’s name, and the time of each (15-minute) check. The infant’s authorized representative and emergency contact shall be notified if any signs of distress or labored breathing are observed. An individual Sleep Plan LIC 9227 shall be completed for each infant up to12 months of age. LPA provided the Licensee with copies of the Infant Safe Sleep information from the Family Child Care Home Licensing Requirements handbook.

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Tyler Reyes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025
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: ALVAREZ LEIVA FAMILY CHILD CARE
FACILITY NUMBER: 198020044
VISIT DATE: 09/17/2025
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Items not permitted: LPA provided the Licensee with a picture listing some of the items not permitted in a family childcare home, which include a bouncer, a jumper, and a walker. These items are not allowed to be on the premises of the facility.

Meals: Per Licensee children will have meals in living room. Licensee was advised to ensure all food brought from home is properly labeled and stored. Per Licensee no children have reported food allergies.

Medication: Per Licensee the facility will provide incidental medical services. If required, medication will be inaccessible to children by centrally storing and locking. Medications will be administered in accordance with PIN 22-02-CCP, which outlines requirements for proper storage, documentation, and staff training.

The following on-limit areas that will be used by children were inspected for safety, comfort, and cleanliness. Heating and cooling provided by central air conditioning. LPA observed age-appropriate toys and learning materials. Telephone service is provided via cell phone. LPA observed a fire place on the living room- with a secured with a protective gate. LPA reminded Licensee to ensure all sharps are stored in manner that both inaccessible and age-appropriate for children in care. Per Licensee there are no firearms on the premises. If firearms are present, LPA verified per Title 22 regulations that they are locked, with ammunition stored separately.

Poisons/Cleaning Products: Poisons will be kept keyed locked in the garage. LPA reminded the Licensee to ensure that all poisons are kept key locked and remain inaccessible to children in care. LPA observed no personal hygiene products accessible in on-limit restroom. LPA reminded Licensee to ensure all child safety latches are age-appropriate for children in care.

Outdoor: Children may use the front yard and backyard. Per Licensee children will be supervised during outdoor play. No animal feces were observed. LPA discussed and provided copies of PIN 25-06 Extreme Heat Prevention.

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Tyler Reyes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025
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: ALVAREZ LEIVA FAMILY CHILD CARE
FACILITY NUMBER: 198020044
VISIT DATE: 09/17/2025
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Pool: LPA observed an in-ground pool. LPA conducted an inspection of the in-ground swimming pool to ensure compliance with the Health and Safety Code Section 1596.814 and safety standards for Family Child Care Homes. LPA observed the pool area for appropriate safety guards, self-closing, self-latching gate, pool cover, and overall inaccessibility to children. LPA observed the pool with the following drowning safety preventions a Pool Safety Alarm ASTM F2208 operational, Life Ring approved U.S.C.G, and a rescue pole with a body hook. LPA observed a access gate self closing, self latching and key lockable.

Staff Files: LPA reviewed Licensee Siomara, Carlos, and S1 file for the following records: LIC 9052 Employee Rights, LIC 9108 Statement Acknowledging Requirements to Report Child Abuse, Proof of Immunizations, and Mandated Reporting Training Certificate. Based on record review S1 was missing proof of immunization which poses a potential health and safety risk.

Children Files: LPA reviewed child 1 (C1-C2) file for the following documentation: LIC 282 Affidavit Regarding Liability Insurance, LIC 700 Identification and Emergency Information, LIC 627 Consent for Emergency Medical Treatment, LIC 995A Notification of Parents’ Rights, and LIC 9224 Acknowledgment of Receipt of Licensing Reports it was not applicable.

LPA conducted an interview with Licensee regarding the following topics: infant safe sleep practices, the facility’s plan to support children’s learning and development, procedures for keeping parents informed, strategies for managing challenging behaviors, and protocols for managing food allergies. LPA discussed reporting requirements and the staff’s responsibilities as a mandated reporter, including the obligation to report to Community Care Licensing and emergency personnel when necessary.

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.

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Tyler Reyes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025
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: ALVAREZ LEIVA FAMILY CHILD CARE
FACILITY NUMBER: 198020044
VISIT DATE: 09/17/2025
NARRATIVE
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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for 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 Siomara 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 and must remain posted for 30 days consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. Exit interview conducted and Appeal Rights provided with Licensee Siomara. Please see attached LIC 809-D for citations.

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NAME OF LICENSING PROGRAM MANAGER: Karen Chambers
NAME OF LICENSING PROGRAM ANALYST: Tyler Reyes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/17/2025 04:20 PM - It Cannot Be Edited


Created By: Tyler Reyes On 09/17/2025 at 03:53 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: ALVAREZ LEIVA FAMILY CHILD CARE
FACILITY NUMBER: 198020044

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/17/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
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:

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 LPA observed multiple electrical outlets within the facility uncovered and unsecured which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/24/2025
Plan of Correction
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Licensee will ensure facility is free from defects and conditions which might endanger a child. Licensee will ensure all electical outlets has an electrical outlet cover. POC will be cleared by visit.
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, the licensee did not comply with the section cited above LPA observed a fire extinguisher in the day care room with an expired service tag August 7,2024 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/24/2025
Plan of Correction
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Licensee will ensure to maintain a new or serviced fire extinguisher annually. Licensee will service fire extinguisher or purchase a fire extinguisher. POC will be cleared by a visit.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Karen Chambers
NAME OF LICENSING PROGRAM MANAGER:
Tyler Reyes
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/17/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/17/2025 04:20 PM - It Cannot Be Edited


Created By: Tyler Reyes On 09/17/2025 at 03:53 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: ALVAREZ LEIVA FAMILY CHILD CARE
FACILITY NUMBER: 198020044

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/17/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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 [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
Plan of Correction
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Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
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.
Karen Chambers
NAME OF LICENSING PROGRAM MANAGER:
Tyler Reyes
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/17/2025


LIC809 (FAS) - (06/04)
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