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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216015
Report Date: 05/07/2024
Date Signed: 05/07/2024 11:54:15 AM

Document Has Been Signed on 05/07/2024 11:54 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/
DIRECTOR:		MARIA ELENA MUNIZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 862-9417
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
05/07/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Antoinette MunizTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 5/7/2024 at 11:00 AM Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced case management inspection and met with Licensee, Antoinette Muniz. . The purpose of the inspection is to conduct a Confirmation of Removal (COR) for Jose Curiel and to ensure Jose Curiel is not present at the Family Child Care Home (FCCH) There were 6 day care children present at the time of the inspection.

On 2/9/2024, the Department notified the facility that Jose Curiel does not have a criminal record clearance and Jose Curiel cannot work, reside, or be present at the facility unless a criminal record exemption is granted. An exemption denial letter was mailed and issued to Licensee, Antoinette Muniz.

During today’s inspection, LPA did not observe Jose Curiel. Per Licensee, Jose Curiel does not reside or work at the facility. Licensee provided LPA a copy of the signed Confirmation of Removal for Jose Curiel (LIC 300B). Licensee is informed she is required to notify parents of children currently in care that Jose Curiel has been removed from the home. Licensee is to have a copy of Addendum To Notification of Parent's Rights (LIC 995B) for each child in care.



Exit interview conducted with Licensee Antoinette Muniz. A copy of the Appeal Rights (LIC 9056) were given and explained.

Continued on LIC 809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/07/2024
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: MUNIZ FAMILY DAY CARE
FACILITY NUMBER: 426216015
VISIT DATE: 05/07/2024
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Verification of removal is complete. No deficiencies cited.

This evaluation report and Exemption Denial letter must be posted for 30 days.

Notice of Site Visit has been posted (LIC9213). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. Copies of this report must be posted for 30 days in a visible location for the authorized representatives of children.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024
LIC809 (FAS) - (06/04)
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