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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566211203
Report Date: 02/21/2020
Date Signed: 02/21/2020 01:11:19 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: DATE:
02/21/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Susana MullerTIME COMPLETED:
01:30 PM
NARRATIVE
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On February 21, 2020 at 12:45 AM Licensing Program Analyst (LPA) Laura Villanueva conducted a Case Management-Deficiencies inspection. LPA explained the purpose of the visit and toured the home with Licensee. Upon conducting a complaint investigation, LPA found evidence of an incident that occurred on 11/16/19 that was not reported to the Department. LPA explained to Licensee that she is required to report any unusual incidents that occur at the child care.

California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 809D.”)

Appeal rights given with a copy of the report. Notice of site visit given. Vist was conducted in Spanish.


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: 02/19/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2020
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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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: 02/21/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/19/2020
Section Cited

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 (3) Health and Safety Code Section 1597.467(b)(1) provides in part:
"A report shall be made to the Department…following the occurrence during the operation of a family day care home of any of the following events:(C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child."
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This requirement was not met as evidenced by: Licensee failed to report an incident that occurred on 11/16/19 to the Department which poses a potential health, safety or personal rights risk to children in care.
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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: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Laura VillanuevaTELEPHONE: (805) 722-5138
LICENSING EVALUATOR SIGNATURE:
DATE: 02/19/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/19/2020
LIC809 (FAS) - (06/04)
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