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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021150
Report Date: 06/27/2025
Date Signed: 06/27/2025 03:28:07 PM

Document Has Been Signed on 06/27/2025 03:28 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:HE FAMILY CHILD CAREFACILITY NUMBER:
198021150
ADMINISTRATOR/
DIRECTOR:		HE, XIAOSHANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 988-7212
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 14DATE:
06/27/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Licensee,TIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On 6/27/2025 at 12:30 pm, Licensing Program Analyst (LPA), Monica Ruiz conducted an unannounced annual random inspection of the facility noted above. LPA entered the home through the front door which has security gate. The facility is a large family childcare. LPA met with Licensee who had 15 children present and no assistant. LPA informed Licensee that they were over capacity.
Licensee states that child#15 is her neighbor’s, whose mother had an emergency and would be back soon to pick up the child. Child was picked up at 15 minutes later. Licensee’s husband arrived during inspection to assist Licensee and put the facility back into compliance. Licensee states she has 14 children enrolled.

LPA consulted about age groups and ratio and provided Licensee the Individual Infant Sleeping Plan (LIC 9227) and Earthquake Preparedness Checklist (LIC 9148). Also discussed were the requirements for licensee to have an assistant.

At 1:30pm, LPA observed the pool area that was inspected during the pre-licensing visit on 6/23/2023. LPA conducted another Bodies of Water checklist and tested the 2 pool gates, which were found to be self-closing and self-latching. LPA did not observe a pool alarm, a safety ring or a rescue pole during this inspection. LPA advised that children do not go into the backyard until the safety equipment is purchased and installed.

This is a one-story home which consists of living room, kitchen, breakfast nook, garage, front yard, back yard, side yard, swimming pool, garden area near the back yard, 4 bedrooms and 4 bathrooms.
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NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Monica Ruiz
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/27/2025
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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: HE FAMILY CHILD CARE
FACILITY NUMBER: 198021150
VISIT DATE: 06/27/2025
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A facility roster was available. Per Licensee, operating hours are from Monday - Friday 8:00 am – 5:30 pm and cares for children ages 3 months to 6 years of age.

Licensee states that she provides the following meals: Breakfast, Lunch and PM snack and is not part of a food program at this time. Parents provide baby food, and formula, however, licensee does have extra on hand. Any food items provided by parents must be labeled with child’s name and stored appropriately. LPA advised that breast milk should have the date and child’s name written on the bottle.

Areas used by children were inspected include: Living room, bedroom #1 for napping, bathroom #1, and backyard. Back yard has enclosed area with a child’s gate with bikes, play structure and children’s toys.

The backyard is off-limits until Licensee submits proof of obtaining swimming pool safety equipment as stated in the regulations.

Per Licensee areas off limits include: Bedrooms #2, #3 #4, kitchen, bathrooms #2, #3, #4, garden area, swimming pool and garage. These are kept off-limits and need to be made inaccessible during operating hours.
Licensee states there are no firearms stored in the home, and none were observed on this day. The home was inspected for safety, comfort, cleanliness, ventilation, and telephone service. LPA verified the phone number and email address, which was found to be correct. Fire and safety drills must be performed every 6 months and documented for review by the Department. Licensee states she conducted a fire drill in 4/18/2025 and was documented. No one smokes at the family childcare home. Parent Board was available with all required forms.
When there is not a qualified assistant/adult, Licensee must follow Small Family Child Care Home regulations. A qualified adult is an individual who has a valid and current Pediatric First Aid and CPR training EMSA approved, Immunization's (TDAP, MMR, TB, Influenza (or a waiver for the influenza may be in writing), mandated reporter training and a valid criminal record clearance associated to the facility license.
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NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Monica Ruiz
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2025
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: HE FAMILY CHILD CARE
FACILITY NUMBER: 198021150
VISIT DATE: 06/27/2025
NARRATIVE
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Detergents, cleaning compounds, medications, and other items, which could pose a danger, were determined to be inaccessible to children in care during this inspection. Kitchen knives are kept in a cabinet in a child proof lock and cleaning supplies are under the kitchen sink with a child proof lock which is made inaccessible for children in care. Medications/vitamins were not accessible to children and according to Licensee there are no children on medication at this time.

LPA observed the required 2:A-10:B-C fire extinguisher, which was last serviced October 29, 2024. State Fire Marshall standards, state that fire extinguisher shall be purchased or serviced annually. The smoke and carbon monoxide detector were tested and operating properly during the visit. Currently the facility has pets at this time.

Licensee cares for children 24 months and younger, and safe sleep was discussed and LPA advised of PIN 20-24 CCP Safe Sleep. LPA did not observe a 15-minute safe sleep log for children under 24 months. Licensee states that she sits in the room with the children when they are napping. LPA advised Licensee to keep a 15-minute Sleep Log for each child under 24months and an Individualized Infant Safe Sleep Plan for children under 12 months. The licensee has completed training on preventive health & safety practices. Pediatric First Aid and CPR, which includes the EMSA,

expires 11/10/2026. There are first aid supplies available including surgical scissors, tweezers and emergency manual. Licensee’s Mandated Reporting Training Certificate expires 5/30/2026. LPA advised that all persons working with children require the AB 1207 Mandated Reporting training which needs to be completed every 2 years. The following link http://www.mandatedreporterca.com/ was provided.



Children and staff files must be maintained and updated as needed and must be available for review by the Department. If children and staff leave the day care all records must be maintained for 3 years after leaving. LPA observed that children’s files were complete. LPA advised that the following documents of the LIC 700, LIC 627 and LIC 995A are required, as well as immunization. LIC 282 is also needed if liability insurance is not available.
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NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Monica Ruiz
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2025
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: HE FAMILY CHILD CARE
FACILITY NUMBER: 198021150
VISIT DATE: 06/27/2025
NARRATIVE
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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 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 Childcare 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 reviewed clearance list.

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.
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NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Monica Ruiz
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2025
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: HE FAMILY CHILD CARE
FACILITY NUMBER: 198021150
VISIT DATE: 06/27/2025
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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/. There are no children currently taking medication.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare 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.

The deficiency listed on the following page were observed by the LPA and is being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809-D. The deficiencies that are being cited needs to be cleared to protect the children’s health & safety.

A notice of site visit was given and must remain posted for 30 days. An exit interview was conducted, and report was reviewed with the Licensee, Xiaoshan He.
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NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Monica Ruiz
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/27/2025 03:28 PM - It Cannot Be Edited


Created By: Monica Ruiz On 06/27/2025 at 03:06 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: HE FAMILY CHILD CARE
FACILITY NUMBER: 198021150

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/27/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.814(a)(2)
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:

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 that there is no rescue pole, life ring, or pool alarm or cover, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/25/2025
Plan of Correction
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Licensee states she will obtain a pool alarm, rescue pole and life ring. Licensee will take pictures of corrections made and submit the photos via email.
Type B
Section Cited
CCR
102425(j)(2)(D)
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:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review the licensee did not comply with the section cited above in 1 out of 1 children's files did not have immunization records, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/25/2025
Plan of Correction
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Licensee states they will obtain the child's immunization records and add them to their file.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Katrina Chicote
NAME OF LICENSING PROGRAM MANAGER:
Monica Ruiz
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/27/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2025


LIC809 (FAS) - (06/04)
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