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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198010207
Report Date: 02/03/2022
Date Signed: 02/03/2022 11:13:27 AM

Document Has Been Signed on 02/03/2022 11:13 AM - 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:MAUNEY FAMILY CHILD CAREFACILITY NUMBER:
198010207
ADMINISTRATOR:MAUNEY, GEORGE & LIANGFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 241-3318
CITY:MONTEREY PARKSTATE: CAZIP CODE:
91755
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
02/03/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Licensee, Lilly Mauney TIME COMPLETED:
11:15 AM
NARRATIVE
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Licensing Program Analyst Mireya García conducted an announced Case Management Deficiencies Inspection to address deficiency discovered during visit conducted on December 06, 2021. Due to COVID- 19 precautionary measures were taken, licensing staff present during inspection wore appropriate personal protective equipment. LPA met with Licensee, Lily Mauney who guided LPA on a tour of the facility. There were no children observed to be present at the facility during this inspection. The purpose of this report is to address concerns regarding Reporting Requirements.

On December 06, 2021 During interviews conducted with day care staff disclosures reveal that Staff #2 and Staff #2's family have been residing at the facility since April of 2021. Licensee did not report this to the Department.

During the course of the investigation, an updated LIC 279 was obtained from Licensee with only her residing in the home. Per Licensee Staff #2 and family moved out of the facility on December 22, 2021. In addition, a death certificate was obtained for Licensee George Mauney who died on April 26, 2021. Licensee did not report this to the Department. The facility is being cited for failure to report required information to the Department within the required 24 hours.

Report continues on next page 1 of 2.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 02/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2022
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MAUNEY FAMILY CHILD CARE
FACILITY NUMBER: 198010207
VISIT DATE: 02/03/2022
NARRATIVE
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The deficiency listed on the following page is being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809d.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Licensee, Lily Mauney.


Report ends here page 2 of 2.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/03/2022 11:13 AM - It Cannot Be Edited


Created By: Mireya Garcia On 02/03/2022 at 10:59 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MAUNEY FAMILY CHILD CARE
FACILITY NUMBER: 198010207

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/03/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/11/2022
Section Cited
CCR
102416.2(a)(2)

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102416.2-Reporting Requirements:(a) The licensee shall report the following information the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm). (2) Any change in household composition including adults moving in or out of the home and anyone living in the home who reaches his or her 18th birthday. This requirement is not met by:
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Per Licensee Lily Mauney, facility will comply with reporting requirements in the future and has submitted in writing request to surrender license on 02/11/22. Licensee will submit license to the Department by POC due date 02/11/22.
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LPA's investigation findings reveal that Staff #2 moved into the facility sometime in April of 2021. On January 24, 2022 Licensee disclosed that Staff #2 moved out of the home in December 22, 2021. In addition, a death certificate was obtained for Licensee George Mauney who passed away on April 26, 2021. Licensee did not report this to the Department. This poses a potential health and safety risk to 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:Brandi VanOosten
LICENSING EVALUATOR NAME:Mireya Garcia
LICENSING EVALUATOR SIGNATURE:
DATE: 02/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/03/2022


LIC809 (FAS) - (06/04)
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