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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020197
Report Date: 01/03/2023
Date Signed: 01/03/2023 03:11:34 PM

Document Has Been Signed on 01/03/2023 03:11 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:MURILLO FAMILY CHILD CAREFACILITY NUMBER:
198020197
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 12CENSUS: 4DATE:
01/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:01 AM
MET WITH:Licensee, Cristina MurilloTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Mireya García conducted an unannounced annual required inspection. Due to COVID- 19 precautionary measures were taken, licensing staff present during inspection wore appropriate personal protective equipment. LPA met with licensee, Cristina Murillo who guided analyst on a tour of the facility. The licensee's two minor children and minor (female) resident child were also present during LPAs arrival. There were four (4) children present with one (1) being an infant during this inspection. Licensee states that there are currently 12 children enrolled.

Family members residing in the home are four (4) adults and three (3) children. Criminal record clearances were not on file for two adults; Licensee's son Bryant P. Murillo turned 18 year's of age on 12/21/2022 and family member Patricia Olivares has been residing in the converted garage since October of 2021.

This is a one-story home which consists of 3 bedrooms, 3 bathrooms, living room, dining room, kitchen, den room, converted attached garage, storage room (detached), back yard (fenced), front yard (unfenced) and side yard (fenced). The children use the restroom near the hallway (located in between bedroom #1 and bedroom #2, living room, dining room, kitchen, den, front yard (for arrivals/departures), and back yard (play yard). Per licensee, areas off limits to children and parents include: 3 bedrooms, 2 bathrooms, garage, storage room and side yard). The LPA toured all areas used by children during this visit.
Report continues on next page 1 of 5.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 01/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/03/2023
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MURILLO FAMILY CHILD CARE
FACILITY NUMBER: 198020197
VISIT DATE: 01/03/2023
NARRATIVE
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During this tour, the following was noted: LPA was toured through the interior of the home. Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and central heating for safety and comfort. There were safe toys, play equipment and materials observed for children. LPA did not observe any hazards inside of the home. There is a working telephone service maintained in the home. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. The licensee states that there are no poisons in the home. The licensee does understand that poison must be locked with a key or combination lock.

LPA observed and inspected sleeping equipment for infants. LPA observed two play yards for each infant who is unable to climb out of the play yard. All equipment meets the US Consumer Product Safety Commission safety standards. LPA observed that play yards are free from loose articles and objects. There are no objects hanging above or attached to the side of the play yard. LPA observed that play yards do not hinder the entrance or exit to and from the space they are sleeping in. Mats were observed to be firm and covered with a fitted sheet that is appropriate to the mat size. Each infant has their individual bedding and is washed weekly as required. Soiled bedding is replaced when wet or soiled and is placed in an area inaccessible to infants. Pacifiers were not observed. Licensee was advised that infants shall not be swaddled while in care and all infants up to 12 months should be placed on their back for sleeping.

LIC 9227 (Individual Sleeping Plan) for infants up to 12 months was review. Title 22 Regulation Section 102425(j) Infant Safe Sleep was discussed with the Licensee, including but not limited to documentation that shall be maintained. LPA Garcia discuss, review and provided Licensee with a Spanish/English copy of PIN 20-24 CCP Recently Approved Safe Sleep Regulations in Effect during this inspection. Report continues on next page 2 of 5.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2023
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MURILLO FAMILY CHILD CARE
FACILITY NUMBER: 198020197
VISIT DATE: 01/03/2023
NARRATIVE
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At: 10:25 a.m., during the tour of the exterior of LPA home LPA inspected back yard, side yard and detached storage room and attached converted garage. Per Licensee disclosure adult resident and minor child are family members who are currently living in the converted garage. Per Licensee, adult resident Patricia Olivares and minor child (female), have been residing in the converted garage since October of 2021. Per Licensee, Patricia will be fingerprinted on this date. LPA Garcia obtained Licensee’s disclosure in writing LIC 855, along with plan of correction. A $500.00 civil penalty was assessed on this date.

Per licensee, there are no weapons, firearms or bodies of water on the premises. Children’s records were reviewed to ensure that each child has an Identification and Emergency form. LPA issued the Confidential Names List (LIC 811) to the Licensee during this inspection. The LIC 859 and the LIC 811 documents the staff names recorded and children’s files that were reviewed during this inspection. The valve on the required 2A 10BC fire extinguisher indicates fully charged with a receipt of purchase dated 04/17/2022. At 10:16 a.m., Smoke detector/carbon monoxide detector in the hallway were tested and are in operable condition. The licensee has current Pediatric First Aid and CPR, which will expire 04/2023.

Incidental Medical Services (IMS) policy was discussed. Per Licensee there are currently no children enrolled who required IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm
Report continues on next page 3 of 5.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2023
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MURILLO FAMILY CHILD CARE
FACILITY NUMBER: 198020197
VISIT DATE: 01/03/2023
NARRATIVE
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SB792 (Immunization Requirements for Staff and Employees) was discussed with the Licensee.
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

The following was discussed:


· Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.
· The Licensee shall be present in the home and shall ensure that children are supervised at all times.
· Children shall not be left in park vehicles.
· The capacity specified on the license shall be the maximum number of children for whom care can be provided.
· Car seats shall only be used for transportation purposes and shall not be used for sleeping.
· All children in care have the right to receive safe, healthful, and comfortable accommodations, furnishings and equipment.
· When a child shows signs off illness, they will be separated from other children until the nature if the illness is determined.
Report continues on next page 4 of 5.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2023
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MURILLO FAMILY CHILD CARE
FACILITY NUMBER: 198020197
VISIT DATE: 01/03/2023
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LPA reviewed and issued the LIC 311 - Forms/Records to Keep in Your Family Child Care Home.
CHILDREN’S FORMS/RECORDS, FACILITY FORMS/RECORDS and INFORMATION TO BE POSTED, Disaster drills, posting requirements, children records requirements, mandated child abuse and injury/death reporting, and criminal record transfer requirements were discussed.

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

The following deficiencies are being cited in accordance to Title 22 of the California Code of Regulations and/or Health & Safety codes. Please refer to LIC809D for documentation of deficiencies cited:

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). Acknowledgement of Receipt (LIC 9224 form) must be maintained in each child’s file immediately upon receipt from parent. Licensee, Cristina Murillo was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224) Form (English/Spanish).

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



Exit interview conducted and report was reviewed with facility representative, Cristina Murillo.
Report ends here page 5 of 5.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/03/2023 03:11 PM - It Cannot Be Edited


Created By: Mireya Garcia On 01/03/2023 at 01:49 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: MURILLO FAMILY CHILD CARE
FACILITY NUMBER: 198020197

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/03/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview disclosures from Licensee's and minor child adult resident Bryant and Patricia are residing in the home and have not been fingerprinted cleared, this poses an immediate health, safety to persons in care.
POC Due Date: 01/03/2023
Plan of Correction
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LPA Garcia obtained a written statement (LIC 855) from Licensee which indicates the plan of correction; to have her adult son Bryant and adult resident Patricia get fingerprinted today 01/03/2023 and will submit proof via email to LPA Garcia by POC due date 01/03/23
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.
SUPERVISOR'S NAME:Brandi VanOosten
LICENSING EVALUATOR NAME:Mireya Garcia
LICENSING EVALUATOR SIGNATURE:
DATE: 01/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/03/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/03/2023 03:11 PM - It Cannot Be Edited


Created By: Mireya Garcia On 01/03/2023 at 01:49 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: MURILLO FAMILY CHILD CARE
FACILITY NUMBER: 198020197

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/03/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records review of Child #4 is missing LIC 9227 Individual Infant Sleeping Plan on file, this poses a potential health and safety risk to children in care.
POC Due Date: 01/13/2023
Plan of Correction
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Per Licensee, she will review and discuss LIC9227 with Child #4's parent, upon obtaining signed LIC 9227 Licensee will review and send copy of signed LIC 9227 to LPA Garcia via email by POC due date 01/13/2023.
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 records review of Child #4 is missing documentation of infant's safe sleep log which shall include observations of; signs of distress, labored breathing, flushed skin color, increase body temperature, restlessness, or any signs of distress, with date and time of each 15 minute check while child #4 is sleeping; this poses a potential health and safety risk to children in care.
POC Due Date: 01/13/2023
Plan of Correction
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Per Licensee, she will document and maintain Child #4's sleeping log on file for upon CCLD review. Licensee will send copy of completed sleeping log via email to LPA Garcia by POC due date 01/13/2023.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Brandi VanOosten
LICENSING EVALUATOR NAME:Mireya Garcia
LICENSING EVALUATOR SIGNATURE:
DATE: 01/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/03/2023


LIC809 (FAS) - (06/04)
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