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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493819
Report Date: 08/03/2022
Date Signed: 08/03/2022 03:13:14 PM

Document Has Been Signed on 08/03/2022 03:13 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: 15CENSUS: 11DATE:
08/03/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Maria Morales, LicenseeTIME COMPLETED:
03:30 PM
NARRATIVE
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On 08/03/2022, Licensing Program Analyst (LPA) Silva Garibyan conducted a Case Management- Deficiencies visit for the purpose of citing for the deficiencies that were observed during the investigation of Complaint CONTROL NUMBER 58-CC-20220802081835.
LPA met with Maria Morales, Licensee and discussed the purpose of the visit. Licensee was present with 11 children (including four infants and 7 preschool age children).
LPA observed the following deficiency:

102370(d)(1): All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility Obtain a California clearance or a criminal record exemption as required by the Department.
LPA Garibyan observed assistant #1 present in the home and caring for children. Assistant stated this is her second week working (started on 07/25/2022) in the facility and has not completed her Live Scan. This poses an immediate safety risk to children when un-fingerprinted adults work in the home and have direct contact with them.. Civil Penalty assessed.

The facility was issued a Type A citation and civil penalty in violation of Title 22 regulations. (See LIC 809-D for deficiency page).
LPA discussed AB633 and informed licensee that, upon receipt of a Type A deficiency, the licensee shall post and provide copies of this licensing report to parent/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

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: Rita Ramos
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE: DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/03/2022
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 2
Document Has Been Signed on 08/03/2022 03:13 PM - It Cannot Be Edited


Created By: Silva Garibyan On 08/03/2022 at 02:41 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: 08/03/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/03/2022
Section Cited
CCR
102370(d)(1)

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All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility Obtain a California clearance or a criminal record exemption as required by the Department.
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Licensee agrees to remove Ana from the facility effective immediately and not allow her to return until clearances are received. Licensee will submit written plan of correction to CCL by 7/10/22.
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This requirement is not met as evidenced by: on 8/03/22 Ana Roma was present and has not completed Live Scan. LPA observed that individual providing care and supervision. This poses an immediately H&S to children in care.
Civil Penalty was issued
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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:Rita Ramos
LICENSING EVALUATOR NAME:Silva Garibyan
LICENSING EVALUATOR SIGNATURE:
DATE: 08/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/03/2022


LIC809 (FAS) - (06/04)
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