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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 136609945
Report Date: 02/26/2020
Date Signed: 05/28/2020 10:58:24 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:REBELIN-SILVA,LORENA FAMILY CHILD CAREFACILITY NUMBER:
136609945
ADMINISTRATOR:LORENA REBELIN-SILVAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 370-0239
CITY:HEBERSTATE: CAZIP CODE:
92249
CAPACITY:14CENSUS: 4DATE:
02/26/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Lorena Rebelin-Silva TIME COMPLETED:
01:15 PM
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On February 26, 2020, at 2:00 p.m., Licensing Program Analyst (LPA), Michelle Palacio conducted an unannounced Required - 1 Year Inspection and met with the Licensee, Lorena Rebelin-Silva. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. Four (4) children and two (2) staff were present in the facility during this inspection. Licensees husband was also present during the inspection and was located in the back yard. This facility is a two story, 3 bedroom, 3 bathroom house. Licensee accompanied LPA inside and out of the facility during this inspection. The following areas used for childcare are: great kids room, kitchen, downstairs bathroom . Off limits areas are garage area and complete upstairs and are inaccessible through use of safety gates and door knob covers.

The fire extinguisher (3A-40BC), smoke detector, and carbon monoxide detector met requirements and are located in the kitchen and dining area .Additional fire extinguishers are located outside in the backyard. All hazardous items were inaccessible to children. The licensee has toys, play equipment and materials available. The home has a fenced backyard available for outdoor activities. Licensee stated there are no weapons in the home. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Licensee was accompanied by Aid Norma Sanchez who is also certified in CPR & First Aid. Licensee’s First Aid and CPR certifications expire on 10/2020. Licensee has required immunization's. Licensee is currently exempt from Mandated Reporter Training. 4 of 4 children’s records were reviewed and contain immunization documentation. 2 of the children’s records are pending Notification of Parent’s Rights form. During inspection licensee was registered to receive quarterly update from Child Care Licensing Department. Licensee was also advised the status of their annual dues.

LPA provided and discussed the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, and ensure that all adults residing or working in the home have criminal background clearances or exemptions. Licensee was reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers and/or similar equipment are not allowed in daycare. Licensee was also provided handouts with information regarding upcoming Safe Sleep Regulations/SIDS, Lead exposure and Shaken Baby Syndrome. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Michelle PalacioTELEPHONE: (619) 767-2216
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020
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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: REBELIN-SILVA,LORENA FAMILY CHILD CARE
FACILITY NUMBER: 136609945
VISIT DATE: 02/26/2020
NARRATIVE
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LPA provided and discussed the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, and ensure that all adults residing or working in the home have criminal background clearances or exemptions. Licensee was reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers and/or similar equipment are not allowed in daycare. Licensee was also provided handouts with information regarding upcoming Safe Sleep Regulations/SIDS, Lead exposure and Shaken Baby Syndrome. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

LPA discussed and provided Licensee with the following: child care advocates email address: childcareadvocatesprogram@dss.ca.gov . In addition, for general questions or questions regarding licensing requirements contact the Child Care Licensing Duty Line at (619) 767-2248.

If no IMS provided:
Incidental Medical services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.


California Code of Regulations, (Title 22, Division 12 & Chapter, 102419(d)(1) , are being cited on the attached LIC 809-D.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Michelle PalacioTELEPHONE: (619) 767-2216
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: REBELIN-SILVA,LORENA FAMILY CHILD CARE
FACILITY NUMBER: 136609945
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/26/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/12/2020
Section Cited

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Parental Rights. The licensee shall request the child’s parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06). The bottom portion of this form must be kept in the child’s file as proof that the parent or authorized representative has been notified.
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Based on records review, the licensee did not ensure the bottom portion of the LIC 995A was maintained in the child’s file. This acknowledges that the parent received and has read the LIC 995A.
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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: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Michelle PalacioTELEPHONE: (619) 767-2216
LICENSING EVALUATOR SIGNATURE:
DATE: 02/26/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/26/2020
LIC809 (FAS) - (06/04)
Page: 2 of 3