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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216015
Report Date: 08/02/2024
Date Signed: 08/02/2024 09:46:12 AM

Document Has Been Signed on 08/02/2024 09:46 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: 7DATE:
08/02/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Antoinette MunizTIME VISIT/
INSPECTION COMPLETED:
09:50 AM
NARRATIVE
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On 8/2/2024 at 8:40 AM Licensing Program Analyst, (LPA) Gigi Reyes conducted an unannounced Plan of Correction (POC) Inspection at the above Family Child Care Home (FCCH) and met with co Licensee, Antoinette Muniz. LPA explained the purpose of the inspection. LPA and co Licensee toured the home including the inaccessible areas.

On 7/23/2024, Licensee was cited of one Type A deficiency
102416.5 Staffing Ratio and Capacity
(3) (e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).

During today's inspection, FCCH is operating within capacity limit, LPA observed 7 children at home under the care of co licensee, Antoinette Muniz. LPA also observed the evaluation report dated 7/23/2024 that document the type A citation is posted at the interior side of the main door of the FCCH. The copies of the same report were provided to parents of day care children which were acknowledged in the Acknowledgement of Receipt of Licensing Reports. (LIC9224)

Continued on LIC 809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 08/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2024
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: 08/02/2024
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During today's inspection, no deficiency was cited.

Notice of Site Visit was issued and must remain posted for 30 days.

Exit interview conducted and report was reviewed with co - licensee, Antoinette Muniz
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2024
LIC809 (FAS) - (06/04)
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