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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628583
Report Date: 05/22/2023
Date Signed: 05/26/2023 03:23:10 PM

Document Has Been Signed on 05/26/2023 03:23 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:CHEMSI, MOUNIA FAMILY CHILD CAREFACILITY NUMBER:
376628583
ADMINISTRATOR:MOUNIA CHEMSIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 988-6622
CITY:CHULA VISTASTATE: CAZIP CODE:
91913
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
05/22/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Mounia ChemsiTIME COMPLETED:
04:36 PM
NARRATIVE
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On 05/22/2023 at 02:35 PM, Licensing Program Analyst (LPA) Edgar Campana conducted a case management inspection regarding issues detected during a complaint inspection conducted on the same day.

During complaint inspection tour of the facility, LPA E. Campana observed that the daycare restroom is under construction and there is no other approved or acceptable restroom available for daycare use. Also, based on conducted interviews, it has been determined that the daycare restroom has been unavailable for approximately one week and the facility failed to report this unusual incident to CCL. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC809-D).

LPA informed facility Licensee, Mounia Chemsi, that this report dated 05/22/2023 documents one (1) Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.



Also, LPA informed Licensee to provide a copy of this licensing report dated 05/22/2023 that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with Licensee, Mounia Chemsi. A copy of this report, along with Appeal Rights (LIC9058 03/22), were provided. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

*This is an amended version of a report that was created on 05/22/2023*
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Edgar Campana
LICENSING EVALUATOR SIGNATURE: DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/26/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
Document Has Been Signed on 05/26/2023 03:23 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 05/26/2023 01:35 PM


Created By: Edgar Campana On 05/22/2023 at 03:04 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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: CHEMSI, MOUNIA FAMILY CHILD CARE
FACILITY NUMBER: 376628583

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/26/2023
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 that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.
This requirement was not met as evidenced by:
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Licensee stated that she will not provide care to potty trained daycare children until restroom is repaired and inspected.
Licensee stated that she will advise LPA once repairs have been completed.
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Based on LPA observations, the facility's daycare restroom is under construction and there is no alternative restroom for children's use, which poses an immediate health and safety risk to children in care.
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*This is an amended version of a report created on 05/22/2023*

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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:Jason Garay
LICENSING EVALUATOR NAME:Edgar Campana
LICENSING EVALUATOR SIGNATURE:
DATE: 05/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/26/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/22/2023 04:40 PM - It Cannot Be Edited


Created By: Edgar Campana On 05/22/2023 at 03:39 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
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: CHEMSI, MOUNIA FAMILY CHILD CARE
FACILITY NUMBER: 376628583

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/30/2023
Section Cited
CCR
102416.2(b)

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102416.2(b) Reporting requirements. The licensee shall report to the Department any of the events as specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C) that occur during the operation of the family child care home.
This requirement was not met as evidenced by:
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Licensee stated that she will fax/mail/email the completed LIC 624B form to the CCL reagrding the restroom incident. Licensee agrees they will watch the Depart. training video about reporting requirements.
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Based on LPA interviews conducted, Licensee did not comply with the above regulation by not reporting that the daycare restroom was under construction and not available for facility use, which poses a potential health & safety risk to children in care.
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This training is at
https://ccld.childcarevideos.org/family-child-care-providers/child-care-reporting-requirements/
LPA gave Lic. a hard copy of CCR 102416.2. The Lic. agrees to give LPA a written statement describing which incidents will be reported to CCL and when the verbal report will be made.

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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:Jason Garay
LICENSING EVALUATOR NAME:Edgar Campana
LICENSING EVALUATOR SIGNATURE:
DATE: 05/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/22/2023


LIC809 (FAS) - (06/04)
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