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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304314163
Report Date: 09/15/2023
Date Signed: 09/15/2023 04:32:05 PM

Document Has Been Signed on 09/15/2023 04:32 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:MONTANO, EMILIAFACILITY NUMBER:
304314163
ADMINISTRATOR:MONTANO, EMILIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 848-7840
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92647
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
09/15/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:01 PM
MET WITH:Licensee Emilia MontanoTIME COMPLETED:
05:00 PM
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On 09/15/2023, Licensing Program Analyst (LPA) Romy Castanon conducted a Case Management due to deficiencies observed during today's inspection. LPA Castanon met with Licensee Emilia Montano. LPA observed an assistant who was caring for 6 daycare children. Emilia's own 3 three children were also present during the visit.

A review of the Facility Personnel Report Summary on 09/15/2023 indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions, with the exception of Nelly Fabila (start date: 03/27/2023). LPA informed Licensee that Nelly was not listed as associated to the facility on report summary. Upon further review of Guardian records, Nelly is cleared to work but was not associated to the new facility number after a relocation. Licensee submitted the documentation for Nelly to be associated in LPA’s presence. A civil penalty is being assessed today.
During LPA’s tour of the facility, LPA observed an infant sitting in a booster seat that was strapped to a folding chair. LPA informed Licensee that the booster seat needed to be secured on a dining room style chair for safety. The Licensee removed the seat from the chair and stored the chair in the kitchen.

Based on LPA’s observation and interview with Licensee, the facility is being cited in accordance with California Code of Regulations, Title 22, Division 12, Section 101170(d)(2) Criminal Background Clearance for one (1) assistant not associated to work at the facility and 102423 Personal Rights for the booster seat.

Appeal Rights were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Licensee Emilia Montano. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. Licensee shall have LIC9224 (Acknowledgement of Receipt) signed and kept in each child's file. (End of Report)
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Romelia M Castanon
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2023
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 09/15/2023 04:32 PM - It Cannot Be Edited


Created By: Romelia M Castanon On 09/15/2023 at 03:28 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MONTANO, EMILIA
FACILITY NUMBER: 304314163

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
09/18/2023
Section Cited
CCR
102370(d)(2)

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(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:(2) Request a transfer of a criminal record clearance as specified in Section 102370(j) This requirement is not met as evidence by
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Licensee submitted LIC 9182 to Orange County Regional Office fax/email during visit. Nelly Fabila is not able to return to the facility until the assocation is cleared. Licensee will contact Licensing office to confirm association and notify LPA via email by POC date.
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LPA observed Assistant Nelly Fabila caring for 6 daycare children. After review of personnel report and Guardian, Nelly was not listed but had a clearance and needed to be associated. This is an immediate risk to the health, safety or personal rights of the children in care.
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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:Patricia Magana
LICENSING EVALUATOR NAME:Romelia M Castanon
LICENSING EVALUATOR SIGNATURE:
DATE: 09/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/15/2023 04:32 PM - It Cannot Be Edited


Created By: Romelia M Castanon On 09/15/2023 at 03:59 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MONTANO, EMILIA
FACILITY NUMBER: 304314163

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
09/18/2023
Section Cited
CCR
102423(a)(2)

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102423 Personal Rights(a) Each child receiving services from a family child care home shall have certain rights...(2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. This requirement is not met as evidenced by:
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Licensee removed the booster seat from the folding chair. The folding chair was stored away in the kitchen during LPA's visit. Licensee will submit a photo of the booster seat if placed on dining room style chair by POC date via email.
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Based on LPA's observation, an infant was in a booster seat strapped on a folding chair. This is a potential health, safety or personal rights risk to the children in care.
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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:Patricia Magana
LICENSING EVALUATOR NAME:Romelia M Castanon
LICENSING EVALUATOR SIGNATURE:
DATE: 09/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2023


LIC809 (FAS) - (06/04)
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