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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020935
Report Date: 03/03/2025
Date Signed: 03/03/2025 11:18:48 AM

Document Has Been Signed on 03/03/2025 11:18 AM - 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:CARLSON FAMILY CHILD CAREFACILITY NUMBER:
198020935
ADMINISTRATOR/
DIRECTOR:		CARLSON, NUBIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 715-5565
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 0DATE:
03/03/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:28 AM
MET WITH:Nubia CarlsonTIME VISIT/
INSPECTION COMPLETED:
11:35 AM
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Licensing Program Analyst (LPA) Veronica Martinez Garza conducted an unannounced Annual/Random inspection at the above facility on 03/03/25 at 09:28 a.m. LPA met with, Nubia Carlson licensee who stated that she is not operating today as her hours of operation have changed. LPA stated that she could return on a different date to conduct the annual inspection; however, licensee indicated it was fine for LPA to conduct inspection. Licensee guided LPA on a tour of the facility. There were 0-day care children present during this inspection. LPA observed licensee’s (3) minor children were present. Per licensee, 08 children are enrolled. Operation hours are Tuesday – Friday 07:45 a.m. 05:15 p.m.

This is a one-story home which consists of 2 bedrooms, 2 bathrooms, living room, family room/playroom dining room, kitchen, laundry room, garage, and backyard (fenced). Areas accessible to children include the family room which is the main day care room, 1 bathroom, and back yard (fenced) for play. Per licensee, areas off limits to children and parents include 2 bedrooms, 1 bathroom, living room, dining room, kitchen, laundry room, and garage. Per licensee, there is 1 fish in a small fish tank on the premises. Per licensee, family members residing in the home are 2 adults and 2 minors. All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing, or volunteering in a licensed home and are identified on the attached LIC811.

LPA toured all areas identified on the facility sketch used by children during this visit and were inspected for safety, comfort, and cleanliness. According to the licensee, parents utilize the side gate for pick up and drop off which leads to the back yard and family room. Tour began in family room where LPA observed age-appropriate toys, equipment, and materials for children. The family room has a sliding door that leads to the back yard and detached garage. The sliding door remains closed when children are indoors. Due to the recent change in hours of operation, children will nap on cots. LPA observed that the licensee closes the doors leading to the kitchen and bedrooms to make it inaccessible to children. LPA toured the children’s bathroom located next to the laundry room.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE: DATE: 03/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/03/2025
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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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: CARLSON FAMILY CHILD CARE
FACILITY NUMBER: 198020935
VISIT DATE: 03/03/2025
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Children can access the bathroom from the back yard or through the kitchen. All laundry products are locked and inaccessible to children. The children’s bathroom is in safe and in sanitary conditions. There’s also a first aid kit readily available.

LPA observed the following required posted documentation in the laundry room of the facility: Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPA reviewed facility records LIC 610- Emergency Disaster Plan and Disaster drill log. All homes shall conduct fire and disaster drills at least once every six months and document the date and time of each drill. Last drill conducted on 03/03/25 during inspection. Children’s roster was available during this inspection.

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

Per licensee, food is provided to children. Licensee was advised that if food is brought from the children’s homes, all containers must be labeled with the child’s name and properly stored or refrigerated. There is a telephone service via a cellphone that remains in the facility during hours of operation. There is ventilation and heating.

Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children. The licensee states that there are poisons locked in the garage and inaccessible to children. Per licensee, there are weapons in the home that meets title 22 regulations.

At 09:35 a.m. smoke and carbon monoxide detectors were observed to be operable. The valve on the required 2A10BC fire extinguisher indicates fully charged and was purchased on 01/20/25, per the attached receipt. Per State Fire Marshall standards, fire extinguishers shall be serviced annually.

The isolation area for sick children waiting to be picked up is outdoors with supervision.

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

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

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2025
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: CARLSON FAMILY CHILD CARE
FACILITY NUMBER: 198020935
VISIT DATE: 03/03/2025
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LPA did not observe any pools, spas, hot tubs, fishponds, or similar bodies of water during the inspection.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, and LIC 995A Notification of Parents’ Rights, LIC 9227- Infant sleep form (0-12 months, and documentation of 15-minute Infant Sleep Check (0-24 months). LPA observed all children’s files to be complete.

Licensee’s records were reviewed for approved Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate. Licensee’s Mandated Reporter Training expires on 08/04/25. Licensee’s Pediatric CPR/FA expires on 04/22/25.

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

Licensee is currently caring for her infant child. LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. No infant walkers, No baby bouncers, No Johnny jumpers, No exersaucers, and any other item that falls into that category.

The licensee is operating within proper capacity and ratios. LPA observed the licensee to be present at the home and providing adequate care and supervision.

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/.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2025
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: CARLSON FAMILY CHILD CARE
FACILITY NUMBER: 198020935
VISIT DATE: 03/03/2025
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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.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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

At this time, the facility is in compliance with California Title 22 Regulations. Therefore, there are no deficiencies being issued today.

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

Exit interview conducted and report was reviewed with the licensee Nubia Carlson.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2025
LIC809 (FAS) - (06/04)
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