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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304311806
Report Date: 12/07/2023
Date Signed: 12/07/2023 12:36:48 PM

Document Has Been Signed on 12/07/2023 12:36 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:MUNIZ RAQUELFACILITY NUMBER:
304311806
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 10CENSUS: 6DATE:
12/07/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Raquel Muniz - LicenseeTIME COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Carmen Odom conducted an unannounced case management inspection for the purpose of increase in capacity from Small Family Childcare Home to Large Family Childcare Home. LPA met with the Licensee, Raquel Muniz, who provided care and supervision to 6 children, which were 2 infants, and 4 preschool age children. Also present was licensee’s adult son, Hector Juarez Muniz.

A review of the Facility Personnel Report Summary indicates adult residents, who require caregiver background check clearances, transfers, exemptions have been obtained and they are cleared.
Licensee stated, she is not currently registered with any Resource Foster Care agency or holds a Resource foster parent license. Licensee was reminded if changes, to notify the licensing office.

Operation hours are Monday to Friday 6:00 AM to 6:00 PM and care and supervision shall be provided to children ages infant and preschool age children.

All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a single-story family home with 3 bedrooms, 1 full bathroom, family room, living with dining area, kitchen, attached garage and back yard with an in ground pool.

Areas that are used by children were inspected for safety, comfort, cleanliness, telephone service (cell phone is the primary contact phone. Ventilation and heating. There is central heat in the home.
Detergents, cleaning compounds, medicines, sharp objects, and hazardous items that can pose a danger to children are inaccessible in areas designated for children. The Licensee states (that there are no poisons on the premises). Licensee was advised that any poisons must be locked with a key or combination lock.

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SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Carmen Odom
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MUNIZ RAQUEL
FACILITY NUMBER: 304311806
VISIT DATE: 12/07/2023
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Licensee has designated living room with dining room, family room, kitchen area, and one bedroom. There is a child proof doorknob on the handle of the bedroom downstairs which is off limit to children. Garage door is in the hallway also has a child proof knob to make it inaccessible to children.

During this inspection, LPA observed the designated off-limits areas were closed and locked.

Areas Designated for Day care activities: Parents and children enter the home, through the main door of the home, the children walk into the living/ dining area and family room that is designated Day care room. The designated Day care room is also for infant care, which was observed to have the required Infant items. There are 2 playpens and toddler beds arranged towards the wall of the dining area and a changing table in the family room, storage cubbies on entrance and a closed off area for the infants in the living room. Highchairs are placed in the dining area and rearranged as needed. Licensee has age-appropriate furniture, toys and educational items for the ages to be served.

The bathroom is located down the hall on the right side, children shall walk from the day care rooms through the hallway turn right straight ahead. The children's bathroom was observed to be safe and free of hazardous items.

Licensee shall provide Breakfast, AM/PM snacks, lunch if food is brought from home and these containers shall be labelled with their names by the parents and stored accordingly.

Licensee stated there are no firearms, or weapons in the facility.

The value on the 2A10 BC fire extinguisher indicates fully charged, as indicated on service tag observed. Smoke and carbon monoxide detectors were tested and are operable.



LPA's discussed the Safe Sleep practice with the Licensee Maria Rabanal.
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials
LPA reviewed with applicant the following safe sleep best practices:
· Always place infants on their backs for sleeping.
· Use only a tight-fitting sheet on the crib or play yard mattress.
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SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Carmen Odom
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MUNIZ RAQUEL
FACILITY NUMBER: 304311806
VISIT DATE: 12/07/2023
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· Do not hang any items from the crib or above the crib.
· Keep all items, including blankets, out of the crib or play yard.
· Pacifiers may be used if they do not have items attached to them.
· Infants should not be swaddled or have any items covering them while sleeping.
· The temperature of the room should be comfortable enough for an adult to wear a T-shirt and not be too hot or too cold.
Licensee shall maintain LIC 9227 form & Sleeping plan in the infant file.
Hard copy and link of Child Care Providers Guide to Safe Sleep provided to licensee on this day: https://www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf

OUTDOOR PLAY AREA: The outdoor area is all fenced with concrete, cement, and grass flooring. Several age-appropriate toys and climbing structures are arranged. Back yard is safe for outdoor activities.

There are bodies of water in the home. The home has an in-ground pool located on the right side of the backyard. There is a 5-foot metal fence around the entire pool with a gate that swings away from the pool. The door had a lock on the top of the door. LPA completed the bodies of water checklist.

APPLICANT WILL WAIT UNTIL FACILITY OPENS TO DETERMINE IMS NEEDS: 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: http://www.ada.gov/childqanda.htm.

Review of records to be maintained: LPA reviewed with the Licensee, Maria Rabanal the LIC 311D, Forms/Records to Keep in Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

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SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Carmen Odom
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MUNIZ RAQUEL
FACILITY NUMBER: 304311806
VISIT DATE: 12/07/2023
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OTHER INFORMATION AND FORMS PROVIDED: Capacity Handout for a Large Family Child Care Home. LPA explained the age requirements for the enrolled children ensuring that when there are 8 children, at least one child is enrolled in Kindergarten or 6 years old, to be in compliance with Title 22 requirements and additional forms were given to the applicant.

LPA reviewed Title 22 Regulation Section 102423 Personal Rights including but not limited to: no intimidation, no humiliation, and no corporal punishment.

At 9:30am five children's files of children present today were reviewed, both infants were missing LIC9227 Individual Safe Sleep Plan. Licensee did not have a napping log for the infants in care. Roster was complete.

Licensee’s file was reviewed, Mandated Reporter Training certificate expires 7/2024 and CPR and 1st aide expires 03/2024.

The facility was not in compliance and violations of the California Code of Regulations, Title 22, Division 12 were observed, discussed, and cited at the time of the visit. The following violations of the California Code of Regulations, Title 22; Division 12, were observed and cited today: 102425(c) Infant Safe Sleep, and 102425(j)(2)(D) Infant Safe Sleep

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

A copy of this report and Appeal rights were presented to the Licensee Raquel Muniz in Spanish.

Fire clearance has received on 11/27/2023. A license with the change in capacity for 14 children (Large Family Childcare home) will be issued after final review and management approval.

SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Carmen Odom
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023
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Document Has Been Signed on 12/07/2023 12:36 PM - It Cannot Be Edited


Created By: Carmen Odom On 12/07/2023 at 11:23 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MUNIZ RAQUEL
FACILITY NUMBER: 304311806

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/07/2023
Section Cited
CCR
102425(j)(2)(D)

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102417 Infant Safe Sleep (j) The provider shall supervise infants while they are sleeping... (2)The provider shall check and document the following:... Documentation shall include the following: a. Date. b. Infant’s name. c.Time of each 15-minute check. This requirement was not met:
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LIcensee stated they will have both parents complete the LIC9227 and file in child's file.
Licensee wil submit a copy of the form completed to licensing office by 12/14/23.
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Based on observation and records reviewed at 9:30 am LPA requested to check the napping log and licensee did not have a napping log for both infants. This poses as a potential Health and Safety to the children in care.
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Type B
12/07/2023
Section Cited
CCR102425(c)

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102425 Infant Safe Sleep (c) An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 month of age the provider has in care and maintained at the facility in the infant’s file. This requirement was not met:
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LIcensee stated they will have both parents complete the LIC9227 and file in child's file.
Licensee wil submit a copy of the form completed to licensing office by 12/14/23.
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Based on observation and records reviewed at 9:30am 2 infants did not have the LIC9227 Infant Safe Sleep form competeled. This poses as a potentail Health and Safety for the 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:Judy Hanson
LICENSING EVALUATOR NAME:Carmen Odom
LICENSING EVALUATOR SIGNATURE:
DATE: 12/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/07/2023


LIC809 (FAS) - (06/04)
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