<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566211203
Report Date: 08/08/2019
Date Signed: 08/09/2019 12:33:43 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:MULLER FAMILY CHILD CAREFACILITY NUMBER:
566211203
ADMINISTRATOR:SUSANA MULLERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 382-1739
CITY:OXNARDSTATE: CAZIP CODE:
93035
CAPACITY:14CENSUS: 9DATE:
08/08/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Susana MullerTIME COMPLETED:
01:30 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
 Amended Report-Changes to Plan of Correction on 809D page

Licensing Program Analyst (LPA) Laura Villanueva made an unannounced visit to the home for a Case Management-Deficiencies inspection. On April 3, 2019, LPA Villanueva conducted an annual random visit and observed deficiencies that needed to be corrected.

Licensee did not submit corrections. LPA toured home with Licensee. Fire extinguisher was serviced on 4/18/19 and the last fire drill was completed and logged on 7/15/19. Licensee's CPR/First Aid is valid until 10/15/20 and Assistant's is valid until 2/23/20. LPA reviewed children's files and found them incomplete.
LPA provided Licensee with copies of required documentation for children.

Licensee has completed the pertussis vaccination. Licensee needs influenza and measles immunizations. The Assistant needs to submit proof of all required immunizations. Licensee has updated children's immunization records.

Licensee will be updating Emergency Disaster Plan and submitting updated form.

Today, Type B deficiencies cited under Title 22 Division 12. Appeal rights given.


THIS REPORT MUST BE FILED IN FACILITY FILE AND MADE AVAILABLE FOR PUBLIC REVIEW FOR 3 YEARS.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Laura VillanuevaTELEPHONE: (805) 722-5138
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: MULLER FAMILY CHILD CARE
FACILITY NUMBER: 566211203
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/08/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/08/2019
Section Cited
HSC
1597.622(a))(1)
1
2
3
4
5
6
7
 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. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement was not met as evidenced by Licensee does not have evidence of her influenza and measles immunization and Assistant's influenza, pertussis, and measles.
1
2
3
4
5
6
7
Licensee will submit proof of immunizations to CCL at an office by 8/22/19. Licensee and Assistant will attend an in person Child Care Orientation on September 12, 2019 at Child Care Resource Center located at 221 Ventura Blvd, Oxnard, CA 93036
Type B
08/08/2019
Section Cited
CCR
102417(g)(8)
1
2
3
4
5
6
7
Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.
1
2
3
4
5
6
7
Child roster is not up to date. Licensee will submit an up to date child roster to CCL by 8/22/19. Licensee and Assistant will attend an in person Child Care Orientation on September 12, 2019 at Child Care Resource Center located at 221 Ventura Blvd, Oxnard, CA 93036
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Laura VillanuevaTELEPHONE: (805) 722-5138
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2