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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400016
Report Date: 05/15/2024
Date Signed: 05/15/2024 12:03:47 PM

Document Has Been Signed on 05/15/2024 12:03 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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:MANZO FAMILY CHILD CAREFACILITY NUMBER:
198400016
ADMINISTRATOR/
DIRECTOR:		MARIA MANZOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 706-9033
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY: 14TOTAL ENROLLED CHILDREN: 13CENSUS: 4DATE:
05/15/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:31 AM
MET WITH:Licensee Maria ManzoTIME VISIT/
INSPECTION COMPLETED:
12:20 PM
NARRATIVE
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On May 15, 2024 Licensing Program Analyst (LPA) A. Wallin conducted an unannounced case management inspection at facility listed above. LPA met with licensee, Maria Manzo. During inspection, LPA observed four children and two staff providing care and supervision present during the inspection. During inspection, at 11:35 am, LPA observed A1 enter facility. Per licensee is cleared and associated to facility. Per review of facility personnel summary report, LPA confirmed A1 is cleared adult resident.

During the visit LPA reviewed four children and three staff records. Per children record review, LPA observed four children’s record missing and incomplete without parent or parent representative signatures. Per licensee, four children present are new and do not have completed records at this time. A type B citation issued.



Per staff record review, LPA observed licensee and one staff with updated CPR/1st aid certificate with expiration date of 6/2025. Per staff record review, LPA observed licensee and two staff missing updated mandated reporter certificate. A type B citation issued. Per staff record review, LPA observed licensee missing immunizations for pertussis and influenza. Per staff record review, LPA observed two staff missing immunizations for measles, pertussis, influenza and TB clearance. A type B citation issued.

Exit interview was conducted and report was reviewed with the Licensee, Maria Manzo. A notice of site visit A notice of site visit was given and must remain posted for 30 days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. During inspection, appeal rights were provided.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Angelica Wallin
LICENSING EVALUATOR SIGNATURE: DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/15/2024
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 05/15/2024 12:03 PM - It Cannot Be Edited


Created By: Angelica Wallin On 05/15/2024 at 11:36 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MANZO FAMILY CHILD CARE
FACILITY NUMBER: 198400016

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/31/2024
Section Cited
HSC
1596.8662(a)(2)

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Provide training including statewide guidance on the responsibilities of a mandated reporter who is a licensed day care provider or an applicant for that license, administrator, or employee of a licensed child day care facility in accordance with the Child Abuse and Neglect Reporting Ac
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Per licensee, mandated reporter certificates for all staff to be completed and evidence proof of completed certificates to be submitted via email.
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Per staff record review, LPA observed licensee and two staff missing updated mandated reporter certificate.
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Type B
05/31/2024
Section Cited
HSC1596.7995(a)(1)

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Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center 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.
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Per licensee, immunizations for all staff to be obtained and evidence proof of obtained immunizations to be submitted via email.
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Per staff record review, LPA observed licensee missing immunizations for pertussis and influenza. Per staff record review, LPA observed two staff missing immunizations for measles, pertussis, influenza and TB clearance.
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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:Angelica Wallin
LICENSING EVALUATOR SIGNATURE:
DATE: 05/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/15/2024


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 05/15/2024 12:03 PM - It Cannot Be Edited


Created By: Angelica Wallin On 05/15/2024 at 11:45 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MANZO FAMILY CHILD CARE
FACILITY NUMBER: 198400016

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/31/2024
Section Cited
CCR
102421(a)

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The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).
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Per licensee complete children's records to be obtained and evidence proof of completed children's records to be submitted via email.
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Per children record review, LPA observed four children’s record missing and incomplete without parent or parent representative signatures.
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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:Angelica Wallin
LICENSING EVALUATOR SIGNATURE:
DATE: 05/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/15/2024


LIC809 (FAS) - (06/04)
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