198400175-4-21-2023-54-CC-AESA-CR52CY-20230421171732

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400175
Report Date: 04/21/2023
Date Signed: 04/21/2023 05:17:41 PM

Document Has Been Signed on 04/21/2023 05:17 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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	MUNOZ FAMILY CHILD CARE		FACILITY NUMBER:	198400175
ADMINISTRATOR:	ELIZABETH MUNOZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 965-8533
CITY:	BELLFLOWER	STATE: CA	ZIP CODE:	90706
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 12	DATE:	04/21/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	03:20 PM
MET WITH:	Licensee Elizabeth Pulido		TIME COMPLETED:	05:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Austin Estrada conducted an unannounced required 1-year inspection at the above facility. LPA met with the Licensee Elizabeth Munoz and informed her of the purpose for the visit. LPA provided the inspection Entrance Checklist (LIC 126). Licensee guided LPA on a tour of the facility. There were 12 children, and one additional staff present during the inspection. All adults present during the inspection have obtained a criminal record clearance or exemption. Individuals residing in the home have been discussed and noted. Licensee provides care to children ages newborn to 13 years old and operation days/ hours are Monday through Friday 8 AM to 5 PM. This is a single-story home. The home consists of 4 bedrooms, 2 restrooms, living room (day care room), family room, kitchen, back yard (fenced) and an additional dwelling unit (ADU). Areas accessible to children are: Living room (playroom), bedroom located next to the living room, kitchen, hallway bathroom and backyard. Areas off limits to children and parents are: three bedrooms and ADU. The restroom that children use was observed safe and sanitary. LPA observed sleeping cots available for children to use in the playroom. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection: LPA reviewed required posted documentation for Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. All documents were observed to be posted in the day care room. Facility records were reviewed for LIC 9040- Facility Roster, LIC 610A- Emergency Disaster Plan and Verification of Disaster and Fire Drills. The last drill was conducted on 1/6/23. All documents were observed during the inspection. There is an operable carbon monoxide detector and a smoke detector in the home. A fully charged Fire extinguisher (2A10BC) was observed and last serviced on 7/28/22. The home maintains telephone service (mobile). LPA observed cleaning compounds, medication, and sharp objects such as knives located in kitchen area inaccessible to children in care. Per Licensee, no children require medication.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Austin Estrada
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023

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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Document Has Been Signed on 04/21/2023 05:17 PM - It Cannot Be Edited

Created By: Austin Estrada On 04/21/2023 at 04:57 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: MUNOZ FAMILY CHILD CARE	FACILITY NUMBER: 198400175
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/21/2023

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
1 2 3 4	Based on record review, the licensee did not comply with the section cited above: Licensee did not have the mandated reporter training certificate for S2 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/05/2023
	Plan of Correction
1 2 3 4	Licensee will provide proof of mandated reporter training certificate for S2 to LPA via email by POC due date.

Type B

Section Cited

HSC

1597.622(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above: licensee and S2 did not have immunization records for Measles at the time of inspection which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/19/2023
	Plan of Correction
1 2 3 4	Licensee will provide proof of immunization record to LPA via email by POC due date.

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:

Valarie Cook

LICENSING EVALUATOR NAME:

Austin Estrada

LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023

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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MUNOZ FAMILY CHILD CARE	FACILITY NUMBER: 198400175
	VISIT DATE: 04/21/2023

NARRATIVE

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Per licensee there are no poisons stored in the home. LPA advised Licensee that all poisons must be locked away, not only inaccessible. Isolation area for sick children waiting to be picked up is in the living room, away from the other children. Per Licensee there are no firearms or weapons stored in the home.
Food is provided by Licensee. LPA advised Licensee if children bring food from home it must be labeled with the child’s name and properly stored or refrigerated.
The home is observed to be clean and orderly. There are toys and other age-appropriate materials available for children. LPA observed a fireplace in the family room made inaccessible to children in care.
The outdoor play area was observed to be fenced and contain toys and other age- appropriate materials available for children. Per Licensee, children are supervised while playing outside. LPA did not observe any pools, spas, or other bodies of water. During the inspection, children present was observed to be treated with dignity and respect, observed to be receiving safe, healthful, and comfortable accommodations, furnishings, and equipment, and free from corporal and/or unusual punishment.
Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, 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) All records were observed to be complete.
Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, and LIC 9108- Statement of Child and Mandated Reporter Training Certificate. Licensee’s CPR/First Aid expires in August 2025 and Mandated Reporter Training Certificate was completed on 6/15/21. LPA observed Licensee and staff member (S2) not to have immunization record for Measles available for review at the time of inspection. LPA advised Licensee that immunization documentation shall be available for review. Licensee did not have the mandated reporter training certificate available for S2 at the time of inspection.
Infant Care: Currently licensee cares for 2 infants. LPAs observed six play yards (four in the playroom and two in the bedroom). LPA reviewed Safe sleep regulations with Licensee, including LIC 9227 (Infant Sleep Plan) for infants under 12 months and 15-minute sleep check documentation for infants 0-24 months. LPA 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 provided a copy of PIN 20-24-CCP: Recently Approved Safe Sleep Regulations in Effect.
Overnight Care: Per Licensee, there is no overnight care is not provided at the moment.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Austin Estrada
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023

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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MUNOZ FAMILY CHILD CARE	FACILITY NUMBER: 198400175
	VISIT DATE: 04/21/2023

NARRATIVE

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LPA discussed the following: Licensee is aware that they must remain wake while children are awake. If children sleep in separate area from licensee, the door must remain open. If licensee cannot hear children when they wake up, video or audio device can be used.
Incidental Medical Services (IMS): 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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm
LPA provided and discussed PIN 23-06-CCP Information Regarding Brightly Colored Fentanyl, Also Referred to as “Rainbow Fentanyl”.
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.
LPA advised Licensee that all adults age 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.
Based on the LPA’s observations, interviews and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.
An exit interview was conducted and report was reviewed with Licensee. A notice of site visit was given and must remain posted for 30 days. Failure to maintain posting as required will result in a $100.00 civil penalty. Appeal rights were discussed and provided to the Licensee.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Austin Estrada
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023

LIC809 (FAS) - (06/04)

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