198400175-4-14-2020-54-CC-ECHZ-BNNVXJ-20200414164938

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400175
Report Date: 04/14/2020
Date Signed: 04/14/2020 04:50:12 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 CARE		FACILITY NUMBER:	198400175
ADMINISTRATOR:	ELIZABETH MUNOZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 965-8533
CITY:	BELLFLOWER	STATE: CA	ZIP CODE:	90706
CAPACITY:	14	CENSUS: 0	DATE:	04/14/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	12:37 PM
MET WITH:	Elizabeth Munoz		TIME COMPLETED:	04:55 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	This was a pre-licensing inspection conducted by Elka Chavez, Licensing Program Analyst (LPA) due to COVID-19 and precautionary measures. This pre-inspection was conducted with Elizabeth Munoz, applicant in Spanish via a tele-inspection by use of FaceTime. During this tele-inspection the Licensee took this LPA on a tour of the home. During this tour the following was noted: Applicant applied for a small family child care license. Per applicant, operating hours will be Monday through Friday from 6:00am to 7:00pm. Applicant states that she will care for children from 3 months to 13 years of age. Family members residing in the home are 2 adults. On April 14, 2020 at 12:30 p.m., all areas identified on the facility sketch were inspected. This is a single-story home. The home consists of 4 bedrooms, 1 restroom, living room (day care room), family room, kitchen, back yard (fenced) and detached garage. Parents will enter through the side medal gate which leads to the door located in the the family room. Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service (cell phone), ventilation and heating (central air and heat). Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children. LPA observed cleaning supplies to be kept in a kitchen cabinet that is out of children's reach. LPA also observed a child safety lock in all the kitchen cabinets. The applicant states that there are no poisons in the home, but does understand that if any poison is purchased, it is required to be locked with a key or combination lock. Areas accessible to children are: Living room (day care room), bedroom located next to the living room (day care room) kitchen, hallway bathroom and back yard.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka Chavez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2020

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 6

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: MUNOZ FAMILY CHILD CARE	FACILITY NUMBER: 198400175
	VISIT DATE: 04/14/2020

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Areas off limits to children and parents are: Applicant's master bedroom, two bedrooms located near the hallway bathroom, family room, front yard and detached garage. LPA observed safety door knobs and child safety gates making the off limit rooms inaccessible to children in care. The applicant understands that licensing staff may have access to off-limit areas during inspection visit if necessary. **Rooms that are off-limits need to be made inaccessible during operating hours**

At 12:55pm LPA observed in the family room there is a fire extinguisher and the valve on the 2A10BC fire extinguisher indicates fully charged. LPA observed the smoke detector and carbon monoxide detector to be functioning. Per applicant there are no pets, firearms, weapons and bodies of water in the premises.

LPA inspected the outdoor space. LPA observed outdoor play area (backyard) to be safe. Backyard is adequately fenced. LPA observed the detached garage being used as a laundry room. LPA advised Applicant to make sure that the garage door is locked during hours of operation to ensure that children in care do not have access.

The applicant states that she will provide 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.

The applicant has completed the required Health and Safety Training, Nutrition Training and Pediatric First Aid and CPR which expires 07/2021. There are first aid supplies available. LPA observed the first aid kit in the day care room.

The following was discussed with the applicant:
Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka Chavez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2020

LIC809 (FAS) - (06/04)

Page: 2 of 6

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: MUNOZ FAMILY CHILD CARE	FACILITY NUMBER: 198400175
	VISIT DATE: 04/14/2020

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Civil Penalties may be assessed if not in compliance with the following:
-In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR and Pediatric First Aid certification, TB clearance, immunization's (TDAP, MMR, Influenza), mandated reporter training and a valid criminal record clearance associated to the facility license.
-A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.
-The fire extinguisher type 2A10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.
-Annual fees must be paid promptly and by the due date or a late fee shall be assessed, and/or the License may be terminated.
-Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.
-Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report)
-Fire and safety drills must be performed every six months and documented for review by the Department.
-Smoking is prohibited in a family child care home, 24/7.
-Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
-Dog(s) and or pets are recommended to be isolated from children in care.
-No baby bouncers, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.
-Applicant shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.
-Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are required to be posted.

Inspection Authority: All adults living and working in the home shall be made of aware of the Department’s right to inspection the home, which includes, but is not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.

Isolation for Ill children: When a child is ill he/she shall be separated from other children (reference 102417(e) Operation of a Family Child Care Home).

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka Chavez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2020

LIC809 (FAS) - (06/04)

Page: 3 of 6

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: MUNOZ FAMILY CHILD CARE	FACILITY NUMBER: 198400175
	VISIT DATE: 04/14/2020

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Immunization Requirement: H&S 1597.622: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. The licensee and all adults working with children have proof of immunizations.

Mandated Reporter Training: H&S 1596.8662: Beginning January 1, 2018, all licensed providers, applicants, directors and employees to complete training as specified on mandated reporter duties. Training is available at: www.mandatedreporterca.com

Infant Care: Applicant states that she will care for infants. LPA advised the applicant to sleep infants where they can always be directly supervised. LPA also advised against sleeping infants in a separate room.
LPA provided the applicant with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. Online copy can be downloaded at: https://www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf

Incidental Medical Services (IMS):
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccds.ca.gov. LPA mailed the Forms/Records to Keep in Your Family Child Care Home (LIC 311D) and provided the following forms:

CHILDREN’S FORMS/RECORDS - Children’s files must contain the following documents/information:
1.Parent Notification for Additional Children in Care (LIC 9150)
2. Affidavit Regarding Liability Insurance (LIC 282)
3.Consent for Emergency Medical Treatment (LIC 627)
4.Consent/Verification for Nebulizer Care (LIC 9166)
5.Identification and Emergency Information (LIC 700)

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka Chavez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2020

LIC809 (FAS) - (06/04)

Page: 4 of 6

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: MUNOZ FAMILY CHILD CARE	FACILITY NUMBER: 198400175
	VISIT DATE: 04/14/2020

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

6.Notification of Parent’s Rights (LIC 995A)
7.Caregiver Background Check Process (LIC 995E)
8.Family Child Care Consumer Awareness Information (LIC 9212)
9.California School Immunization Record
10.Acknowledgment of Receipt of Licensing Reports (LIC 9224)

FACILITY FORMS/RECORDS - Facility files must contain the following documents/information:
1.Personnel Records: As required in Title 22, Division 12, Chapter 3. Section, Regulations 102416.1, including but
not limited to, proof of current pediatric first aid, CPR and preventive health practice certificated and criminal record information.
2. Unusual incident/Injury Report (LIC 624B)
3. Child Care Facility Roster (LIC 9040)
4. Notice of Employee Rights (LIC 9052)
5. Statement Acknowledging Requirement to Report Suspected Child Abuse (LIC 9108)
6. Property Owner/Landlord Consent (LIC 9149)
7. Property Owner/Landlord Notification Form (LIC 9151)
8. A copy of your deed or lease/rental agreement
9.Criminal Background Clearance Transfer Request (LIC 9182)

INFORMATION TO BE POSTED IN YOUR FAMILY CHILD CARE HOME – You are required by Law to post the following:
1. Emergency Disaster Plan (LIC 610A)
2. Earthquake Preparedness Checklist (LIC 9148)
3. Notification of Parent’s Rights (PUB 394)
4. Facility License (LIC 203)
5. A Notice of Site Visit (LIC 9213) must remain posted for 30 days (during the hours that children are in care)
after each site visit by a Licensing Representative.
6. Any Licensing Report documenting a type “A” citation must be posted for 30 days during the hours that children are in care.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka Chavez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2020

LIC809 (FAS) - (06/04)

Page: 6 of 6

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: MUNOZ FAMILY CHILD CARE	FACILITY NUMBER: 198400175
	VISIT DATE: 04/14/2020

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

7. Any Licensing Report or other document verifying compliance or non-compliance with the Department’s order to correct a Type “A” deficiency must be posted for 30 days during the hours that children are in care.

OTHER INFORMATION MAILED:
• Handouts provided for Never Shake a Baby
• Sudden Infant Death Syndrome (SIDS) and
• Safe Sleeping practices
• Capacity Handout for a Small Family Child Care Home and Large Family Child Care Home was provided.
• California Child Passenger Safety Law/ Car Seat Safety Law
• Fire and Earthquake Drill Record

At this time, applicant is in compliance with California Title 22 Regulations. After further review by the department, applicant will be notified if/when License is granted. Once licensed, the applicant is required to adhere to the terms and limitations as stated on the license.

Exit interview was conducted with Elizabeth Munoz, via tele-inspection, during which appeal rights were explained. This report along with a copy of the appeal rights will be sent to the Applicant via email with a read receipt or confirmation of receipt of email, which will act as the Applicants signature.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka Chavez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2020

LIC809 (FAS) - (06/04)

Page: 5 of 6