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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400175
Report Date: 08/03/2021
Date Signed: 08/03/2021 12:10:41 PM

Document Has Been Signed on 08/03/2021 12:10 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:MUNOZ FAMILY CHILD CAREFACILITY NUMBER:
198400175
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
08/03/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Elizabeth MunozTIME COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Elka Chavez conducted an unannounced annual inspection to the above facility in Spanish on 8/03/2021. LPA arrived at the facility at 9:10 AM and met with Licensee, Elizabeth Munoz, Licensee who guided analyst on a tour of the facility. Also present during this inspection, was, Licensee’s Spouse and Gracie Urrea, assistant. Per Licensee, there are 8 children that are currently enrolled. A current children’s roster was available for review. There were 5 children present upon arrival.

This is a single-story home. The home consists of 4 bedrooms, 1 restroom, living room (day care room), family room, kitchen, back yard (fenced) and detached garage. Parents enter through the side medal gate which leads to the door located between the kitchen and the family room. Areas accessible to children are: Living room (day care room), bedroom located next to the living room (infant day care room) kitchen, hallway bathroom and patio in the back yard (fenced). Areas off limits to children and parents are: Applicant's master bedroom, two bedrooms located next to the hallway bathroom, family room, front yard and detached garage. LPA observed safety door knobs and child safety gates making the off-limit rooms inaccessible to children in care. The licensee understands 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**

Individuals who reside in the home were noted and discussed. Per Licensee, she currently has 1 assistant. All adults present in the home have obtained a criminal record clearance. Licensee states that there are no firearms stored in the home.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There is telephone service via cell phone that is used, and the cellphone stays at the facility during operation hours. There is ventilation and heating (central). Safe toys play equipment and materials were observed. LPA observed the central air was on and operable..
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Elka Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/03/2021
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MUNOZ FAMILY CHILD CARE
FACILITY NUMBER: 198400175
VISIT DATE: 08/03/2021
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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 no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock. The restroom that children use was observed to be safe and sanitary.

The valve on the required 3A40BC fire extinguisher indicates fully charged and was purchased on 6/22/21, as indicated on the receipt. Smoke and carbon monoxide detectors were tested and are operable. LPA observed a carbon monoxide detector and smoke detector in the day care room and infant room.

Licensee states that she is currently caring for infants and there are 2 infants enrolled. Licensee states that the infant will sleep in the infant room where they are constantly supervised. Appropriate sleeping arrangements and cots were observed. Licensee was advised cribs or play yards cannot hinder the entrance or exit from the sleeping space, mattresses shall be firm and covered with a fitted sheet that overlaps the underside, so it cannot be dislodged. Cribs and play yards must be free of loose articles and objects. No objects can be hung above or attached to the side of the crib. LPA advised the Licensee that infants cannot be swaddled, shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age.

Currently, children are using the patio for outdoor play time. The outdoor play area was observed to be fenced. The licensee states that supervision is always provided.

The licensee is observed to be operating within the license capacity limitations. LPA did not observe any children left in parked vehicles. Car seats shall only be used for transportation. LPA did not observe any children sleeping in car seats.

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. LPA observed the licensee's Pediatric First Aid and CPR expired on 7/27/21. LPA issued a technical violation. LPA observed Gracie Urrea, assistant’s pediatric CPR & first aid expires on 7/2023. Licensee stated that she will have assistant start an hour earlier to be in compliance.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Elka Chavez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MUNOZ FAMILY CHILD CARE
FACILITY NUMBER: 198400175
VISIT DATE: 08/03/2021
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Licensee is scheduled to renew her pediatric CPR and first aid on 8/7/2021. There are first aid supplies available. LPA advised that if a child shows signs of illness he/she/they shall be separated from other children.

Children’s records were reviewed, including emergency information and were observed to be complete. The licensee has proof of immunization against influenza, pertussis, and measles.

LPA observed that the Licensee and assistant have current Mandated Reporter AB 1207 Compliant Child Care Training Certificate on file. LPA issued a Confidential Names List (LIC 811) to the licensee which documents staff and children’s files reviewed during this inspection.

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 documented was conducted on 6/25/21.



There are no pets on the premises. LPA did not observe any pools, spas, hot tubs, fish ponds, or similar bodies of water during the inspection. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted. LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family child care facility. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

Incidental Medical Services (IMS):
The licensee states that she will provide IMS. Per licensee, there are no children enrolled that require IMS at this time. Incidental Medical Services (IMS) policy was discussed. 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
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Elka Chavez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MUNOZ FAMILY CHILD CARE
FACILITY NUMBER: 198400175
VISIT DATE: 08/03/2021
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LPA advised the licensee to access forms, regulations and quarterly updates online at: www.cdss.ca.gov. LPA also discussed the Provider Information Notices (PINS) on Safe Sleep Awareness: PIN 19-02-CCP, COVID FAQ - PIN 20-11-CCP and Guardian User Account Access - PIN 20-20-CCLD. LPA provided Licensee with a copy of the Children's Records form (LIC 311D).

No deficiencies cited during today’s visit. Technical violations must be corrected in order to ensure the health and safety of children in care.

Licensee has applied for a large license. Fire inspection for a capacity of 14 was granted by the Los Angeles County Fire Department. After further review by the department, Licensee will be notified if/when large license is granted. Once licensed, the Licensees are required to adhere to the terms and limitation as stated on the license.


Exit interview was conducted with Licensee, Elizabeth Munoz, including, but not limited to Appeal Procedures, Site Visit and Initial Appeal Rights.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Elka Chavez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
LIC809 (FAS) - (06/04)
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