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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197420034
Report Date: 09/18/2023
Date Signed: 09/18/2023 03:14:25 PM


Document Has Been Signed on 09/18/2023 03:14 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:MUNOZ GONZALEZ FAMILY CHILD CAREFACILITY NUMBER:
197420034
ADMINISTRATOR:MUNOZ GONZALEZ, ZIVIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 671-8307
CITY:LOS ANGELESSTATE: CAZIP CODE:
90016
CAPACITY:14CENSUS: 11DATE:
09/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:49 AM
MET WITH:Zivia Munoz GonzalezTIME COMPLETED:
03:30 PM
NARRATIVE
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On 09/18/23 at 9:55 AM, Licensing Program Analysts (LPA) Maria Rendon, met with Licensee, Zivia Munoz Gonzalez. The purpose of this visit was an unannounced Annual Required Inspection at Munoz Gonzalez Family Child Care home located 2619 S. Genesee Ave, to ensure that health, safety and personal rights as requires by Title 22 and Health and Safety Regulations governing California Child Care Homes are met. Days and hours of operation are Monday-Friday 7:30am-7:00pm. There were 11 children and 04 staff present during this inspection.

During the tour of the facility LPA observed 6 infants in care. LPA Rendon informed Licensee, Per CCR 102416.5(d)(1) Staffing Ratio and Capacity (d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either: (1) Twelve children, no more than four of whom may be infants. Licensee stated that she was not aware of the definition of an infant. Licensee thought that the age of an infant is 0-18 months. LPA informed Licensee that by definition an infant is 0-24 months.



Licensee guided LPA on a tour of the facility. The family child care home is a 2 bedroom, 1 bathroom, living room, dining room, kitchen, day care dedicated space and an attached garage.

Current facility sketch reviewed, and Licensee confirmed that living room, 1 bathroom, kitchen, and the area labeled day care dedicated space on the facility sketch are used for providing care and are accessible to children. All other rooms, 2 bedrooms, and garage, are off-limits and made inaccessible by use of doors and child proof door handles.

During the today’s inspection LPA observed children in care in the outdoor area of the home and infants in the day care dedicated space. Licensee informed LPA that there is construction in the home to extend the day care area. LPA confirmed that licensee pg 1 of 4

SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Maria RendonTELEPHONE: 424-301-3023
LICENSING EVALUATOR SIGNATURE:
DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2023
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 5


Document Has Been Signed on 09/18/2023 03:14 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: MUNOZ GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 197420034

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(d)(1)
Staffing Ratio and Capacity
(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either: (1) Twelve children, no more than four of whom may be infants; or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above, licensee had 6 infants in care which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/19/2023
Plan of Correction
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Licensee will review the above regulation. Licensee will provide LPA Maria Rendon a schedule of when infants in care will be in the facility to make sure the care of infants do not overlap and where it does not exceed four infants in care at a time. Licensee will email schedule to LPA Rendon at maria.rendon@dss.ca.gov before the end of business day.
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: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Maria RendonTELEPHONE: 424-301-3023
LICENSING EVALUATOR SIGNATURE:
DATE: 09/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2023
LIC809 (FAS) - (06/04)
Page: 2 of 5


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MUNOZ GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 197420034
VISIT DATE: 09/18/2023
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informed the department of the construction taking place. Licensee will provide an updated facility sketch indicating the additional space for day care.

Areas that will be used by the children were inspected for safety, comfort, cleanliness, ventilation, and heating.

Licensee ensures that children in care are supervised at all times and is aware that children shall not be left alone. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area in the backyard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained.


LPAs observed a fireplace located in the living room and is made inaccessible by a metal enclosure screen and will not be in use during daycare hours. LPAs observed two fire extinguishers 2-A:10-B:C, one in the kitchen and one in the day care dedicated space. LPA observed and tested 1 combo smoke detector/carbon monoxide detector in the day care dedicated space, one smoke detector in the hallway between the bedrooms accessible to children.


LPAs observed 8 mats in the day care dedicated space and 4 play yards in the living room for napping. LPA discussed Safe Sleep Regulations with licensee. There is one play yard for each infant in care and play yard is kept free from all loose articles and objects while infant is sleeping, and there are no objects hanging above or attached to the play yard. Infant is not swaddled while in care. Provider physically checks on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness, and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. LPA reviewed Individual Infant Sleeping Plan and advised to be completed and filed in the child’s file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping.

Licensee states that she provides food for children in care. If food is not provided and food is brought from the children’s homes, containers shall be labeled with child’s name and properly stored or refrigerated.

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SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Maria RendonTELEPHONE: 424-301-3023
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MUNOZ GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 197420034
VISIT DATE: 09/18/2023
NARRATIVE
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There is no swimming pool or other bodies of water on the premises.

Per licensee there are no firearms or ammunition on the premises.

An emergency fire/disaster drill has been completed and documented within the last 6 months. Licensee’s pediatric CPR/First Aid is current. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles. Licensees have completed the Mandated Reporter Training within 2 years. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

LPAs observed the following required postings: current facility license, LIC610A Emergency Disaster Plan, and PUB 394 Notification of Parents’ Rights Poster. LPAs reviewed facility’s current LIC 9040 Child Care Roster. LPAs reviewed a 6 children’s file and found children’s file in compliance with LIC700 Identification and Emergency information, LIC627 Consent for Emergency Medical Treatment, and LIC995 Notification of Parent’s Rights, and immunization records.

Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding


Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA discussed the safe sleep regulations with facility representative and 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 also informed licensee [facility representative] 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. pg 3 of 4
SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Maria RendonTELEPHONE: 424-301-3023
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MUNOZ GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 197420034
VISIT DATE: 09/18/2023
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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.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, Licensee Zivia Munoz Gonzalez, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D) Licensee was provided a copy of appeal rights.

LPA Maria Rendon informed licensee Zivia Munoz Gonzalez that this report dated 9/18/23 documents one Type A citation which shall be posted for 30 consecutive days as there is/ are immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Maria Rendon informed the licensee Zivia Munoz Gonzalez to provide a copy of this licensing report dated 9/18/23 that documents any Type A citation(s) to parents/guardian of all children currently enrolled by the next business day or the next day 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 child’s file for verification.

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.

An exit interview was conducted, a copy of this report and appeal rights were provided and reviewed with the Licensee Ziria Munoz Gonzalez.

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SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Maria RendonTELEPHONE: 424-301-3023
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023
LIC809 (FAS) - (06/04)
Page: 5 of 5