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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376628583
Report Date: 10/21/2022
Date Signed: 10/21/2022 03:27:32 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/19/2022 and conducted by Evaluator Edgar Campana
COMPLAINT CONTROL NUMBER: 20-CC-20221019131958
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:14CENSUS: 14DATE:
10/21/2022
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Mouna ChemsiTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Licensee operating beyond the terms of the license.
INVESTIGATION FINDINGS:
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On 10/21/2022 at 09:15 AM, Licensing Program Analyst (LPA) Edgar Campana, conducted an Inital 10-day complaint investigation regarding the above allegation. Upon visit, LPA met with Licensee, Mounia Chemsi and discussed reason for visit and complaint process. LPA proceeded to tour the facility. Present was an assistant and 14 daycare children, four (4) of whom are infants. LPA also reviewed children's records and cofrimed the age of children present.

Based upon LPA observations and record review, the preponderance of evidence standard has been met and the allegation that Licensee is operating beyond the terms of the license is therefore SUBSTANTIATED. Pursuant to Title 22 of the CA Code of Regulations, the following Type A deficiency was cited (refer to LIC9099-D).
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Edgar CampanaTELEPHONE: (619) 767-2218
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 20-CC-20221019131958
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
VISIT DATE: 10/21/2022
NARRATIVE
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LPA informed facility Licensee, Mounia Chemsi, that this report dated 10/21/2022 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 10/21/2022 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. LPA observed that the notice of site visit was posted during the inspection. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Edgar CampanaTELEPHONE: (619) 767-2218
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 20-CC-20221019131958
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 10/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/24/2022
Section Cited
CCR
102416.5(d)(1)
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(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 shall be..(1) Twelve children, no more than four of whom may be infants.

This requirement not met as evidenced by:
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Licensee contacted parents and two children were picked up before LPA concluded visit. LPA provided Licensee with a capacity regulations visual aid and copy of CCR section 102416.5.
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Based on LPA observations and record review, Licensee did not comply with the above regulation as there were 14 children present, 4 of whom are infants, which poses an immediate health and safety risk to children in care.
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Licensee stated that she will review capacity and ratio regulations and will provide a written statement to Licensing outlining her understanding of regulations by COB 10/24/2022.
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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 GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Edgar CampanaTELEPHONE: (619) 767-2218
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4