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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493819
Report Date: 09/26/2022
Date Signed: 09/29/2022 01:04:58 PM

Document Has Been Signed on 09/29/2022 01:04 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:MORALES FAMILY CHILD CAREFACILITY NUMBER:
197493819
ADMINISTRATOR:MORALES, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 350-1860
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
09/26/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Maria Morales, Licensee and 2 Licensee's assistant TIME COMPLETED:
03:30 PM
NARRATIVE
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On 09/26/2022 1:25pm, Licensing Program Analyst (LPA) Denise Miranda, conducted a Case Management- Deficiencies visit for the purpose of citing for the deficiencies that were observed during the visit on 09/26/2022.

LPA met with Licensee Maria Morales. There were 11 children (who 6 were infants) in care being supervised by Licensee and two assistants. Upon arrival, one infant was living the facility. 1:35pm, LPA observed 10 children who 5 were infants.

Licensee stated that only today she had 6 infants and she is aware that she can have only 4 infants per time.
Licensee was unable to provide copy of the safe sleep log for the 6 infants and lic9227 infant plan for infant#1 and #2. Technical violation was provided to Licensee. .

The facility is found to be in violation of Title 22. Type A and Type B were cited today, 09/26/2022. (See LIC 809-D for deficiencies page).

LPA explained that the deficiency was Type A violation and required immediate correction. Licensee was further informed of AB633 requirements. Licensee was provided for LIC9224 and instructed to provide copies of this report to all parents of children currently enrolled and to obtain the parent's signature on form LIC9224, as acknowledgement that they received a copy of this report. Form LIC9224 is to be retained in the child's file. Licensee was further instructed to complete this same process for all children who enroll in the facility within 12 months of this report date.
Licensee was instructed to post this report, along with the Notice of Site Visit, at the main entrance of the facility for 30 days. Failure to comply with the above posting requirements may result in a civil penalty.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Denise Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2022
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MORALES FAMILY CHILD CARE
FACILITY NUMBER: 197493819
VISIT DATE: 09/26/2022
NARRATIVE
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LPA provided a copy of lic9224 Acknowledgment of Receipt of Licensing Reports.

An exit interview was conducted with Licensee Maria Morales. A copy of this report, Notice of Site Visit, and appeal rights were provided to Licensee.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Denise Miranda
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/29/2022 01:04 PM - It Cannot Be Edited


Created By: Denise Miranda On 09/26/2022 at 02:07 PM
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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MORALES FAMILY CHILD CARE
FACILITY NUMBER: 197493819

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/26/2022
Section Cited
CCR
102416(5)(d)(1)

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(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 .....: (1) Twelve children, no more than four of whom may be infants.
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LPA provided a copy of title 22 - 102416.5 Staffing Ratio and Capacity.Licensee provided a declaration that she understand her ratio and capacity. Licensee contacted parent of child#2 that
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This requirement was not met as evidence by obtained during this inspection. Licensee confirmed that she had 11 children (who 6 were infants present today) and file were reviewed. One infant left when LPA arrived. making Licensee, have 5 infants present. this poses a potential Health and Safety or Personal Rights risk to children in care.
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mother arrived 2:30pm to pick up her child.LPA provided a copy of lic9224 Acknowledgement of Receipt of Licensing Reports that icensee will email to LPA no later than 09/28/2022. Licensee shall have immediately correction.

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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:Lisa Rios
LICENSING EVALUATOR NAME:Denise Miranda
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/29/2022 01:04 PM - It Cannot Be Edited


Created By: Denise Miranda On 09/26/2022 at 02:15 PM
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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MORALES FAMILY CHILD CARE
FACILITY NUMBER: 197493819

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/03/2022
Section Cited
CCR
102416.5(a)

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102421 (a) Child Record (a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d). This requirement is not met as evidenced by: 09/26/22 LPA
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Licensee will submit copies of children's files #10 and #11.
Licensee will mail or drop off to El Segundo office no later than 10/3/2022.
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observed 11 children in care. Licensee was unable to produce files for children #10 and #11
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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:Lisa Rios
LICENSING EVALUATOR NAME:Denise Miranda
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2022


LIC809 (FAS) - (06/04)
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