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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216015
Report Date: 07/15/2022
Date Signed: 07/15/2022 11:08:14 AM

Document Has Been Signed on 07/15/2022 11:08 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:MUNIZ FAMILY DAY CAREFACILITY NUMBER:
426216015
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
07/15/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Antoinette MunizTIME COMPLETED:
11:10 AM
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On 7/15/2022 at 9:50 AM Licensing Program Analyst, (LPA) Gigi Reyes conducted an unannounced Case Management inspection - Licensee Initiated. LPA met with Licensee Ms. Antoinette Muniz and discussed the purpose of the inspection. LPA asked pre screening questions related to COVID-19 , Licensee's responses indicate there are no COVID-19 exposure on site. There were 6 children present during the inspection, both Licensees were also present.

On March 28, 2022 Community Care Licensing (CCL) received an application for an increase in capacity to a Large Family Child Care Home (FCCH). FCCH will use the living room, dining room one bedroom, a bathroom and the fenced backyard. Garage, 2 bedrooms and one bathroom and kitchen are off limits. A fire clearance was granted on July 11, 2022 by Santa Barbara County Fire Department.

During today's inspection, no deficiencies were cited. Notice of site Visit was issued. Exit interview was conducted and report was reviewed with Licensee, Ms. Antoinette Muniz.

Effective today, July 15, 2022 facility is approved to be a Large Family Child Care with a maximum capacity of 14 children.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 07/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/15/2022
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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