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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015539
Report Date: 06/10/2024
Date Signed: 06/10/2024 11:47:26 AM

Document Has Been Signed on 06/10/2024 11:47 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:NUNEZ FAMILY CHILD CAREFACILITY NUMBER:
198015539
ADMINISTRATOR/
DIRECTOR:		NUNEZ, AMPAROFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 810-4865
CITY:LOS ANGELESSTATE: CAZIP CODE:
90042
CAPACITY: 14TOTAL ENROLLED CHILDREN: 41CENSUS: 14DATE:
06/10/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:17 AM
MET WITH:Amparo NunezTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Veronica Martinez Garza conducted an unannounced Annual/Random inspection at the above facility on 06/10/24 at 09:17 a.m. LPA met with Amparo Nunez, licensee who guided analyst on a tour of the facility. There were 14 children present during this inspection (3 infants and 11 preschoolers. No school age children present). Also present during this inspection was the licensee’s assistant Faith Nunez. Per licensee, 41 children are enrolled; however, children have a staggered schedule. Operation hours Monday through Friday from 8:00 a.m. - 5:00 p.m.

This is a one-story home which consists of 2 bedrooms, 1 bathroom, living room, dining room, kitchen, laundry room, front yard (fenced), and back yard (fenced). Areas accessible to children include the living room (main care), dining room, laundry room (converted to activity room), 1 bathroom, front yard (fenced). Areas off-limits to children and parents include: 2 bedrooms, kitchen, and back yard. Per licensee, there are 3 dogs on the premises. 2 dogs are kept in the back yard and 1 small dog is kept on the side of the home. The home has 2 side hallways that are made inaccessible to children. Per licensee, family members residing in the home are 3 adults and 1 minor. All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing, or volunteering in a licensed home and are identified on the attached LIC811.

LPA toured all areas identified on the facility sketch used by children during this visit and were inspected for safety, comfort, and cleanliness. Tour began in the living room and LPA observed toys, materials, and equipment for children in care. LPA also observed 3 play pens and mats in the living room. Per licensee, children nap in the living room. Adjacent to the living room is the dining room. LPA observed child size tables and chairs. LPA observed that the play pens and mats do not hinder the entrance or exit to and from the space they are sleeping in. The play pens do not have anything hanging on the sides or on top. LPA observed that the play pen in the living room has a Boppy Pillow and several thin blankets. According to the licensee, the Boppy pillow and blankets are not used when infants nap. LPA observed a wall heater; however, the licensee stated that it has been turned off for a long time. LPA recommended for licensee to obtain proof of shut off service from the SoCal Gas company. Wall heater is barricaded.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE: DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/10/2024
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 10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: NUNEZ FAMILY CHILD CARE
FACILITY NUMBER: 198015539
VISIT DATE: 06/10/2024
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Licensee also stated that she will use a portable child proof heater if needed. LPA observed a child proof heater Lasko Oscillating Ceramic Heater readily available. The children’s bathroom is located across from both bedrooms. The bathroom children use was observed to be safe and in sanitary conditions. Children do not have access to the kitchen; however, children walk through the kitchen to go to the bathroom and laundry room. The laundry room has been converted to an activity room. LPA observed 1 play pen that is used when an infant wakes up from nap time. Per licensee, it is used to separate children. LPA observed the play pen is stained throughout. According to the licensee, the play pen is washed weekly; however, the stains do not come off. Licensee keeps all knives up high and inaccessible to children in care. There’s also a first aid kit readily available.

LPA observed the following required posted documentation in the entrance/dining room of the facility: Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPA reviewed facility records LIC 610- Emergency Disaster Plan and Disaster drill log. All homes shall conduct fire and disaster drills at least once every six months and document the date and time of each drill. Last drill conducted was on 05/15/24. Children’s roster was available during this inspection and was observed to be current.

LPA did not observe any pools, spas, hot tubs, fishponds, or similar bodies of water during the inspection.

Licensee does understand 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**

Per licensee, food is provided to children in care. Licensee was advised that if food is brought from the children’s homes, all containers must be labeled with the child’s name and properly stored or refrigerated. There is telephone service via a cellphone that remains in the home during operating hours. There is ventilation and heating.

Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children. The licensee states there are poisons stored in the back yard and are inaccessible to children. Licensee understands that all poisons must be locked and inaccessible to children.

At 09:31 a.m. smoke and carbon monoxide detectors were tested and are operable. The valve on the required 2: A 10 BC fire extinguisher indicates fully charged and was serviced on 01/17/23, per the attached service tag. Per State Fire Marshall standards, fire extinguishers shall be serviced annually.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2024
LIC809 (FAS) - (06/04)
Page: 2 of 10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: NUNEZ FAMILY CHILD CARE
FACILITY NUMBER: 198015539
VISIT DATE: 06/10/2024
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The isolation area for sick children waiting to be picked up is in the laundry room with supervision.

Smoking is prohibited in a licensed Family Child Care Home. Per licensee, no one smokes in the home.

Currently children are using the front yard (fenced) for outdoor play with adequate shade and age-appropriate equipment for children in care. LPA did not observe any objects that could be hazardous to children in care. LPA also advised licensee to check with the American Standard Testing Materials for Playground Guidelines and/or to use the manufactures recommendations for the playground equipment in efforts to be more in line with safety guidelines. Licensee understands that children should be supervised at all times.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, and LIC 995A Notification of Parents’ Rights, LIC 9227- Infant sleep form (0-12 months, and documentation of 15-minute Infant Sleep Check (0-24 months). LPA observed child 1 (C1), C2, and C3 are missing the infant safe sleep documentation of 15 minutes. C1, C2, C3, and C6 are missing LIC 282.

Licensee and assistant records were reviewed for approved Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate. Licensee’s Mandated Reporter Training expired on 07/14/24. Licensee’s Pediatric CPR/FA expired on 05/21/24. According to the licensee, she completed the online portion of the Pediatric CPR/FA last weekend and will complete the skills training this weekend. Assistant Faith Nunez does not have a file for review.

AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018, any person who works in a child care facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers

The licensee is not operating within proper capacity and ratios. LPA provided a copy of the capacity regulations sheet. LPA recommends licensee to be referred to the Technical Support Program (TSP) and provided a pamphlet for review. LPA observed licensee to be present at the home and providing adequate care and supervision.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2024
LIC809 (FAS) - (06/04)
Page: 3 of 10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: NUNEZ FAMILY CHILD CARE
FACILITY NUMBER: 198015539
VISIT DATE: 06/10/2024
NARRATIVE
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 Licensee is caring is for infants. LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. LPA provided consultation. LPA provided consultation.

No infant walkers, No baby bouncers, No Johnny jumpers, No exersaucers and any other item that falls into that category.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2024
LIC809 (FAS) - (06/04)
Page: 4 of 10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: NUNEZ FAMILY CHILD CARE
FACILITY NUMBER: 198015539
VISIT DATE: 06/10/2024
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Licensee Amparo Nunez confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

The following deficiencies were cited in accordance with Title 22 of the California Code of Regulations and Health & Safety Codes. Please see 809D for documentation of deficiencies.

Exit interview conducted and report was reviewed with the licensee Amparo Nunez.

Type A citation

LPA Veronica MartinezGarza informed licensee Amparo Nunez that this report dated 06/10/24 document(s) 1 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Veronica MartinezGarza informed the licensee Amparo Nunez to provide a copy of this licensing report dated 06/10/24 that documents any Type A citation(s) 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.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2024
LIC809 (FAS) - (06/04)
Page: 5 of 10
Document Has Been Signed on 06/10/2024 11:47 AM - It Cannot Be Edited


Created By: Veronica Martinez-Garza On 06/10/2024 at 10:53 AM
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: NUNEZ FAMILY CHILD CARE
FACILITY NUMBER: 198015539

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(d)(2)
Staffing Ratio and Capacity
(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, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either: (2) More than twelve and up to fourteen children only if the criteria in Section 1597.465 of the Health and Safety Code are met.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above in LPA observed licensee caring for 14 children (3 infants and 11 preschoolers) which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/17/2024
Plan of Correction
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2
3
4
Per licensee, she will ensure to follow the staggered schedule that is already in place and will speak to parents regarding availability of space. Licensee also stated that a lot of the children will not be coming back due to transitioning to preschool in the summer. LPA obtained a written declaration LIC 855 and LPA provided a copy of the capacity regulation sheet.
Section Cited
Deficient Practice Statement
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4
POC Due Date:
Plan of Correction
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2
3
4
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:Ana Chico
LICENSING EVALUATOR NAME:Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:
DATE: 06/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2024


LIC809 (FAS) - (06/04)
Page: 6 of 10
Document Has Been Signed on 06/10/2024 11:47 AM - It Cannot Be Edited


Created By: Veronica Martinez-Garza On 06/10/2024 at 10:53 AM
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: NUNEZ FAMILY CHILD CARE
FACILITY NUMBER: 198015539

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on observation, the licensee did not comply with the section cited above in Licensee last serviced the fire extinguisher on 01/17/23 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/24/2024
Plan of Correction
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Per licensee, she will service the fire extinguisher and will submit proof to LPA by POC due date.
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in Licensee is not documenting infant safe sleep every 15 minutes for child 1 (C1), C2, and C3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/24/2024
Plan of Correction
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2
3
4
Per licensee, she will ensure to document safe sleep every 15 minutes and will submit proof to LPA by POC due date. Licensee also stated that she will keep record of infant safe sleep.
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:Ana Chico
LICENSING EVALUATOR NAME:Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:
DATE: 06/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2024


LIC809 (FAS) - (06/04)
Page: 7 of 10
Document Has Been Signed on 06/10/2024 11:47 AM - It Cannot Be Edited


Created By: Veronica Martinez-Garza On 06/10/2024 at 10:53 AM
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: NUNEZ FAMILY CHILD CARE
FACILITY NUMBER: 198015539

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above in Licensee does not have a file for assistant Faith Nunez which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/24/2024
Plan of Correction
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2
3
4
Per licensee, proof of completed Mandated Reporter Training for assistant will be submitted to LPA by POC due date.
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above in Licensee's Pediatric CPR/FA expired on 05/21/24 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/24/2024
Plan of Correction
1
2
3
4
Per licensee, once the skills training is completed she will submit proof of the Pediatric CPR/FA to LPA by POC due date.
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:Ana Chico
LICENSING EVALUATOR NAME:Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:
DATE: 06/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2024


LIC809 (FAS) - (06/04)
Page: 8 of 10
Document Has Been Signed on 06/10/2024 11:47 AM - It Cannot Be Edited


Created By: Veronica Martinez-Garza On 06/10/2024 at 10:53 AM
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: NUNEZ FAMILY CHILD CARE
FACILITY NUMBER: 198015539

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.1(a)(10)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information: (10) A signed and dated copy of the Notice of Employee Rights [LIC 9052, (Rev. 03/03)] as required by Section 102416(a) and Section 102417.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above in assistant Faith Nunez does not have a file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/24/2024
Plan of Correction
1
2
3
4
Per licensee, she will submit proof of LIC 9052 for assistant to LPA by POC due date.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) 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 is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above in assistant Faith Nunez does not have a file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/24/2024
Plan of Correction
1
2
3
4
Per licensee, proof of immunizations for assistant will be submitted to LPA by POC due date.
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:Ana Chico
LICENSING EVALUATOR NAME:Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:
DATE: 06/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2024


LIC809 (FAS) - (06/04)
Page: 9 of 10
Document Has Been Signed on 06/10/2024 11:47 AM - It Cannot Be Edited


Created By: Veronica Martinez-Garza On 06/10/2024 at 10:53 AM
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: NUNEZ FAMILY CHILD CARE
FACILITY NUMBER: 198015539

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(m)(3)
Operation of A Family Child Care Home
(3) A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above in LPA observed child 1 (C1), C2, C3, and C6 do not have LIC 282 on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/24/2024
Plan of Correction
1
2
3
4
Per licensee, she will submit completed LIC 282 or proof of liability insurance to LPA by POC due date.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Ana Chico
LICENSING EVALUATOR NAME:Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:
DATE: 06/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2024


LIC809 (FAS) - (06/04)
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