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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493819
Report Date: 10/06/2022
Date Signed: 10/06/2022 02:16:35 PM

Document Has Been Signed on 10/06/2022 02:16 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: 8DATE:
10/06/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:01 PM
MET WITH:Maria Morales, Licensee and one Assistant TIME COMPLETED:
02:21 PM
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On 10/06/2022 12:01pm, 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 09/28/2022 (repeat violation) - Staffing Ratio and Capacity.
Upon arrival LPA Miranda met Maria Morales, Licensee and 1 Assistant. LPA observed 8 children napping (which 04 were infants) with licensee and one assistant. Licensee guided LPA and tour the house.

During this plan of correction visit, LPA observed that Licensee still have 6 infants enrolled on her facility. LPA obtained a declaration from Licensee, regarding the total of infants that sill enroll and how she will maintain her facility in compliance. Per License, she understand that she can have only 4 infants per time. LPA obtained a copy of an update Child Care Facility Roster (form: LIC9040).

Also, LPA reviewed the LIC9224 Acknowledgement of Receipt of Licensing Reports form, that Licensee was instructed to provide copies of the previous 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 the report dated on 09/28/2022. LPA reviewed the forms LIC9224 and observed that Licensee still missing copies of LIC9224 for 4 children's enrolled. Licensee will submit no later than Monday 10/10/2022 copies of LIC9224 signed by parent/guardian of the children to LPA via email. .Licensee will keep this form in children’s file and
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Denise Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2022
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: 10/06/2022
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maintain them available for review. LPA obtained copies of the documents that parents already signed.

LPA observed that Licensee has posted it the Notice of Visits dated on 09/26/2022 and 09/28/2022 on her main entrance gate. (parents board). Licensee will keep the Notice of Visit for 30-days counting the day of the visit.

Based on LPA's observations, review of documents provided, and declaration obtained the Department has evidences to show the facility is in compliance with the Title 22 Regulations – Staffing ratio and capacity and no citation has been cited during this visit.

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: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022
LIC809 (FAS) - (06/04)
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