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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494029
Report Date: 03/09/2023
Date Signed: 03/09/2023 12:52:25 PM

Document Has Been Signed on 03/09/2023 12:52 PM - It Cannot Be Edited

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:NUNES FAMILY CHILD CAREFACILITY NUMBER:
197494029
ADMINISTRATOR:ASHLEY & MARVA NUNESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 658-9039
CITY:COMPTONSTATE: CAZIP CODE:
90220
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
03/09/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Ashley NunesTIME COMPLETED:
12:55 PM
NARRATIVE
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Licensing Program Analyst (LPA) Warren Birks conducted an unannounced Case Management inspection. During a previous visit today LPA observed Co-Licensee Marva Nunes caring for 10 children.

During the course of a previous inspection, LPA discovered that parent #1 gave the facility January 9, 2023 Court documents indicating parent #1's full custody of child #2. However, the Licensee did not issue a new LIC 700 Identification and Emergency form to parent #1. The facility was cited for Child's records.

Licensee A. Nunes indicated that she did not know that she needed to issue parent #1 an LIC 700 Emergency Form because she thought the Court Order was enough documentation. Licensee A. Nunes indicated she will have parent #1 complete an LIC 700 Identification and Emergency Form and submit to the department in order to close the citation.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. This report along with a copy of the appeal rights was provided. Exit interview was conducted with Licensee Ashley Nunes.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE: DATE: 03/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/09/2023
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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Document Has Been Signed on 03/09/2023 12:52 PM - It Cannot Be Edited


Created By: Warren Birks On 03/09/2023 at 12:37 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: NUNES FAMILY CHILD CARE
FACILITY NUMBER: 197494029

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/09/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/16/2023
Section Cited
CCR
102421(b)

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Child's Records: (b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required in Section 102417(g)(7).

This requirement was not met as evidenced by: LPA observed 700 form for child #2 not updated by authorized parent.
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Licensee A. Nunez indicated she will submit the form to Licensing by the POC date.
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This is a potential 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:Karen Chambers
LICENSING EVALUATOR NAME:Warren Birks
LICENSING EVALUATOR SIGNATURE:
DATE: 03/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/09/2023


LIC809 (FAS) - (06/04)
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