Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197420034
Report Date: 04/19/2017
Date Signed 04/19/2017 01:49:28 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME:MUNOZ GONZALEZ FAMILY CHILD CAREFACILITY NUMBER:
197420034
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
04/19/2017
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Zivia Munoz GonzalezTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Karren Starks made an announced visit for the purpose of conducting a Case Management for capacity increase inspection. LPA met with and toured the home with licensee, Zivia Munoz Gonzalez who had 4 children in care. The home is a single story 2 bedroom 1 bathroom home with living room, dining room, kitchen and rear (bonus room) area. Entrance into the facility is via a walkway that leads to the rear of the home with entry into the rear room. Bedroom #1 is off the hallway to the right, belongs to the licensee and her husband and will be used for napping or isolation of ill children. Bedroom #2 is off the hallway to the left and belongs to the licensee's sons, ages 8 & 13 and may be used for napping. The bathroom for children in care is located off the hallway, it was inspected and LPA did not observe any medications, toxins or cleaning compounds that would cause a risk to children in care.
The home appeared to be clean, safe and well ventilated with telephone service. There is a properly barricaded fireplace in the living room that is used to heat the home. The kitchen which is through the dining room to the right, is off limits and made inaccessible by a child safety gate. LPA observed the cabinets and drawers to have safety latches, making all contents inaccessible to children in care. There is a fully charged 2A10BC Fire Extinguisher in the child care room.
Main care is provided in the rear room, LPA observed age appropriate toys and furniture in the rear room. The area when needed, is heated by a portable heater that will heat the area prior to children arriving. The furnace for the home in inoperable and the grates, located in the hallway are covered. The dining room is just to left of the living room and is used for eating. All electrical outlets in child care areas are covered. LPA also observed mats for napping.
There is a small Chihuahua in the home that sometimes interacts with the children, licensee reminded that the dog's shots must be kept current and should me made available if requested. LPA observed a complete First Aid Kit. First Aid/CPR were not current (exp. 10/2016), but licensee provided proof of registration (04/25) at the time of inspection and Preventive Health is on file. There are operable smoke/carbon monoxide detectors in the home which LPA did not test during inspection, due to children napping. Control of property verified by viewing of the deed.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (310) 337-4332
LICENSING EVALUATOR NAME: Karren StarksTELEPHONE: (310) 337-3753
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2017
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, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME: MUNOZ GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 197420034
VISIT DATE: 04/19/2017
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There is a shotgun and BB gun with trigger locks and the ammunition kept separate, in the hall closet.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Sections 102417. When any IMS is provided, a Plan of Operation that includes 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

The backyard was inspected for outdoor use it is fully enclosed. A small climbing apparatus with cushioning was observed as well as sand boxes with covers. Age appropriate toys and furniture were also observed. There is a covered patio area and two storage sheds. The sheds are locked making the contents inaccessible. The fire pit in the middle of the yard is covered and used as a table. LPA did not observe any bodies of water in the yard. Licensee occasionally uses the front yard which is gated for outdoor play.



Licensee reminded that Emergency/Fire Drills must be conducted monthly and documented. Licensee also reminded that smoking is prohibited in the home during child care hours.

Home is ready for a capacity increase with a licensure of 14 children.

Exit interview, copy of report and notice of site visit issued.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (310) 337-4332
LICENSING EVALUATOR NAME: Karren StarksTELEPHONE: (310) 337-3753
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2017
LIC809 (FAS) - (06/04)
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