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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313623618
Report Date: 11/26/2024
Date Signed: 11/26/2024 12:27:30 PM

Document Has Been Signed on 11/26/2024 12:27 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MUNOZ, GISELA & SANDROFACILITY NUMBER:
313623618
ADMINISTRATOR/
DIRECTOR:		MUNOZ, GISELA & SANDROFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 223-2415
CITY:ROSVILLESTATE: CAZIP CODE:
95747
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
11/26/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Gisela MunozTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
NARRATIVE
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On November 26th, 2024, Licensing Program Analysts (LPAs) Erwina Pascual-Golamco and Soleil Marx, met with licensee, Gisela Munoz, for the purpose of conducting a case management inspection.
LPAs observed a census of eight children in care being supervised by the licensee and assistants.

LPAs observed stairs within the home are not barricaded and are accessible to children in care who are under age 5. The licensee stated the baby gate for the stairs broke the previous week and is planning to order a new gate. LPAs observed an accessible body of water on the premises. Licensee has an above ground hot tub/spa in the backyard covered by a hard top that is not secured or locked on any sides, making it accessible to children in care. Licensee stated her spouse had a lock on the spa but is unsure where the lock went. LPAs observed an infant strapped into their car seat for approximately 30 minutes after being dropped off at the facility. LPAs also observed Licensee placed infant back in car seat unstrapped while licensee was changing a diaper. Licensee stated she leaves infant in car seat after bottle feeding so milk can digest.

Based on LPA observations, interview, and record review, three Type A Deficiencies are being cited on LIC809-D page and an immediate civil penalty of $500 is being assessed for an accessible body of water. LPAs informed licensee Gisela Munoz that this report dated 11/26/24 documents three Type A citations which shall be posted for 30 consecutive days as they pose an immediate risk to the health, safety, or personal rights of children in care. LPA informed the licensee to provide a copy of this licensing report dated 11/26/24 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.
This report was reviewed with Licensee, and an exit interview was conducted. Appeal Rights and A Notice of Site Visit (NOS) was provided to Licensee, who will post it for a period of 30 days for parental review.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE: DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/26/2024
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 3
Document Has Been Signed on 12/03/2024 12:22 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 12/03/2024 08:46 AM


Created By: Erwina Pascual-Golamco On 11/26/2024 at 10:35 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: MUNOZ, GISELA & SANDRO
FACILITY NUMBER: 313623618

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/27/2024
Section Cited
CCR
102417(g)(5)(A)

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102417(g)The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to:(5) All licensees shall ensure the inaccessibility of pools....hot tubs, spas,...through a pool cover or by surrounding the pool with a fence.(A) …. Pool covers shall be....locked while the pool is not in use.

This requirement is not met as evidenced by:
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Licensee will install locks that will comply with regulations for the hot tub/spa by POC due date. LPA will conduct POC visit to ensure compliance.
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Based on observation, the licensee did not comply with the section cited above by not locking the hot tub/spa cover which poses an immediate health, safety or personal rights risk to persons in care.
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Type A
11/27/2024
Section Cited
CCR102417(g)(3)

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(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to:(3) Where children less than five years old are in care, stairs shall be fenced or barricaded. This requirement is not met as evidenced by:
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Licensee will order and install a new barricade for the stairs by POC due date. LPA will conduct POC visit to ensure compliance.
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Based on observation, the licensee did not comply with the section cited above by not having stairs barricaded while caring for children under age 5, which poses an immediate health, safety or personal rights risk to persons 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:Natalie Dunaway
LICENSING EVALUATOR NAME:Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:
DATE: 11/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/26/2024


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 11/26/2024 12:27 PM - It Cannot Be Edited


Created By: Erwina Pascual-Golamco On 11/26/2024 at 10:48 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: MUNOZ, GISELA & SANDRO
FACILITY NUMBER: 313623618

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/27/2024
Section Cited
CCR
102425(h)

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102425 (h) Car seats shall only be used for transportation purposes and shall not be used for sleeping.

This requirement was not met as evidenced by:
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Licensee stated she will comply with regulations and only use car seats for its intended purpose. LPA will conduct return POC visit to ensure compliance.
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Based on observation, the licensee did not comply with the section cited above by using a car seat for non transportation purposes, which poses an immediate health, safety or personal rights risk to persons 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:Natalie Dunaway
LICENSING EVALUATOR NAME:Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:
DATE: 11/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/26/2024


LIC809 (FAS) - (06/04)
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