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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493819
Report Date: 09/28/2022
Date Signed: 09/28/2022 04:40:13 PM

Document Has Been Signed on 09/28/2022 04:40 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: 9DATE:
09/28/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Licensee and 2 assistantr TIME COMPLETED:
03:10 PM
NARRATIVE
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On 9/28/2022 1:35pm, Licensing Program Analyst LPA Miranda conducted an unannounced visit for the purpose of a plan of Correction visit. (POC) for the deficiency cited on previous visit of 9/26/2022 - Staffing Ratio and Capacity.

Upon arrival LPA met Maria Morales, Licensee and 2 Assistants. LPA observed 9 children (which 6 were infants) with licensee and two assistants.

Based on LPA's observations, review of documents provided, and declaration obtained the Department has evidences to show the facility is not compliance with the Title 22 Regulations – Staffing ratio and capacity.

The facility is cited Type A citation today 09/29/2022. See LIC 809-D for deficiency cited. This is a repeat violation with a civil penalty.

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.
LPA provided a copy of lic9224 Acknowledgment of Receipt of Licensing Reports.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Denise Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2022
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: 09/28/2022
NARRATIVE
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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.


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: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/28/2022 04:40 PM - It Cannot Be Edited


Created By: Denise Miranda On 09/28/2022 at 03:03 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: 09/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/28/2022
Section Cited
CCR
1012416(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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This is a repeat violation. Licensee provided a declaration that she undersand that she cannot have more than 4 infant when she has 12 chidlren in care. LPA observed Licensee contacted two parents to
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This requirement was not met as evidence by obtained during this inspection. Licensee confirmed that she has 9 children (who 6 were infants present today). This is a repeat violation. This poses a potential Health and Safety or Personal Rights risk to children in care.
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pick their infants. The instructions must include immediately notifying the parent (LIC9224) and seeking instructions on what action to take. Licensee will submit the form LIC9224 to LPA via email no later than tomorrow.

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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: 09/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2022


LIC809 (FAS) - (06/04)
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