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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493813
Report Date: 05/22/2019
Date Signed: 05/22/2019 03:07:45 PM

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:LUNA FAMILY CHILD CAREFACILITY NUMBER:
197493813
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 1DATE:
05/22/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:26 PM
MET WITH:Alma Luna, LicenseeTIME COMPLETED:
03:25 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Rita Ramos and Mireya Garcia conducted an unannounced case management inspection to the above facility. LPAs met with Alma Luna, Licensee, who guided analysts on a tour of the facility. There was 1 child present upon arrival. Also present during this inspection was Licensee's daughter, McKayla Luna.

During this inspection LPAs observed that the LIC 9040- Child Care Facility Roster was not updated. Therefore, the following deficiency on the attached LIC 809 deficiencies page is being cited in accordance with California Code of Regulations Title 22.

The Notice of Site Visit (LIC 9213)- must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with Alma Luna, including but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019
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: LUNA FAMILY CHILD CARE
FACILITY NUMBER: 197493813
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/22/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/22/2019
Section Cited
CCR
102417(g)(8)
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Current roster of children provided care in facility required.
Each child day care facility shall maintain a current roster of children who are provided care in the facility.

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During LPA's inspection Licensee updated facility roster.
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This requirement is not met as evidenced by LPAs observing that the Licensee did not have the facility roster updated. This poses a potential health and safety risk.
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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: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019
LIC809 (FAS) - (06/04)
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