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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018152
Report Date: 02/13/2020
Date Signed: 02/13/2020 03:57:16 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:MUNOZ FAMILY CHILD CAREFACILITY NUMBER:
198018152
ADMINISTRATOR:MUNOZ, JUDYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 208-8517
CITY:BELL GARDENSSTATE: CAZIP CODE:
90201
CAPACITY:14CENSUS: 5DATE:
02/13/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:29 PM
MET WITH:Judy Muniz, LicenseeTIME COMPLETED:
04:00 PM
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Case Management Inspection conduced in Spanish
Licensing Program Analyst, LPA Alicia Mooberry conducted a case management incident visit for the purpose of following up on an Unusual Incident Report dated 5/17/19. Per licensee, mom brought Child 1 (C1) wrapped up in blanket, C1 walked in home while mom took other child out of the stroller. C1 walked in the house and fell hitting his head on the floor. Per licensee, child's mom usually brought C1 with torso wrapped in a blanket and when child fell could stop the fall because hands were in blanket.
C1 is no longer enrolled on childcare

Mom took child to the doctor and Licensee followed up the following day and mom said child was fine.



Exit interview was conducted with Judy Minuz, Licensee .
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2020
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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