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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010084
Report Date: 11/17/2023
Date Signed: 11/19/2023 10:43:34 PM

Document Has Been Signed on 11/19/2023 10:43 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:MUNOZ ARREOLA, CARMEN FCCHFACILITY NUMBER:
493010084
ADMINISTRATOR:MUNOZ ARREOLA, CARMENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 889-1056
CITY:SANTA ROSASTATE: CAZIP CODE:
95404
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 13DATE:
11/17/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:45 PM
MET WITH:Migdalia Diaz and Maria MedinaTIME COMPLETED:
08:20 PM
NARRATIVE
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A Case Management inspection was made to the facility by Licensing Program Analyst (LPA), Leticia Rosales-Meza. LPA met with Licensee's assistants, Maria Medina and Migdalia Diaz (S1) and (S2). S1 stated that Licensee, Carmen Munoz Arreola (L1) was not present and would not return until Sunday. S1 stated that L1 left out of town on an emergency basis.

During the course of an inspection, LPA toured the facility inside and outside. LPA observed thirteen children being supervised by S1 and S2, there were seven infants under 24 months, and six preschool aged children resulting in the facility, operating out of ratio.

The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided.

Notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with S1, Migdalia Diaz.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Leticia Rosales
LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2023
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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Document Has Been Signed on 11/22/2023 12:08 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 11/21/2023 09:20 AM


Created By: Leticia Rosales On 11/17/2023 at 06:24 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: MUNOZ ARREOLA, CARMEN FCCH
FACILITY NUMBER: 493010084

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/18/2023
Section Cited
HSC
1597.465(b)

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Staffing Ratio and Capacity: A large family day care home may provide care for more than 12 children and up to and including 14 children, if all of the following conditions are met. No more than three infants are cared for during any time when more than 12 children are being cared for.
This requirement was not met as evidenced by:
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S1 stated that a Plan of Correction will be submited by the Licensee on 11/29/23.
On today's date, 11/21/23 Licensee stated she will immediately disenroll some infants to place her back into compliance. Licensee stated "I will no loger be out of ratio".
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During today's inspection, there were 13 children present, 7 of which were infants, resulting in the facility being out of ratio.

This poses/posed an immediate health, safety and/or personal rights risk to the children in care.
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Licensee will submit a written statement to LPA by 11/29/23. The written statement shall included the names of infants terminated from her care, as well as how she will ensure staying in compliance.
Email: [email protected]

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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:Alexis Hollon
LICENSING EVALUATOR NAME:Leticia Rosales
LICENSING EVALUATOR SIGNATURE:
DATE: 11/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/17/2023


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 11/19/2023 10:43 PM - It Cannot Be Edited


Created By: Leticia Rosales On 11/17/2023 at 08:44 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
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: MUNOZ ARREOLA, CARMEN FCCH
FACILITY NUMBER: 493010084

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/08/2023
Section Cited
CCR
102417(a)

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Operation of a Family Child Care Home: The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence.
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Licensee will submit a Plan of Correction stating will be present in the home 80% per day by 12/08/23.

Email: [email protected]
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Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

This requirement is not met as evidenced by:
The licensee was not present today, left out of town.
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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:Alexis Hollon
LICENSING EVALUATOR NAME:Leticia Rosales
LICENSING EVALUATOR SIGNATURE:
DATE: 11/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/17/2023


LIC809 (FAS) - (06/04)
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