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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 136610426
Report Date: 05/29/2019
Date Signed: 05/29/2019 02:01:38 PM

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:SANCHEZ, SILVIA FAMILY CHILD CAREFACILITY NUMBER:
136610426
ADMINISTRATOR:SILVIA SANCHEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 768-9163
CITY:CALEXICOSTATE: CAZIP CODE:
92231
CAPACITY:14CENSUS: 5DATE:
05/29/2019
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
01:14 PM
MET WITH:Rite LieraTIME COMPLETED:
02:05 PM
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Licensing Program Analyst (LPA) Yolanda Baez arrived at the facility to conduct a case management inspection. LPA Baez met with Helper, Rita Liera. Licensee arrived within 5 minutes. There were 5 children present at the time of the inspection (4 toddlers and 1 school age child).

LPA Baez conducted a tour of the home to ensure compliance with standards established in CCR, Title 22, Division 12, Chapter 3. Licensee is using the following areas for day care: day care/ play room, dining area, kitchen, one hallway bathroom, the second living room (located near the hallway bathroom), and the back yard. The following areas are kept inaccessible through the use of door locks or safety gates: the garage, studio (across the main entry way near the kitchen), 3 bedrooms, and 2 bathrooms. The back yard is fully fenced and used for outdoor activities.

All cleaners, toxins, medications and other hazardous substances are inaccessible to children in care and are located in off limits areas. The home is clean, orderly, and has adequate ventilation. Children’s toys and play equipment is safe and age appropriate. The fire alarm and CO2 monitor are operational. Licensee stated that there are no firearms or ammunition on the property. There were not any bodies of water observed throughout today's inspection. LPA Baez verified a working telephone number. Pediatric CPR and First-Aid certificate for Licensee is valid through 01/2020. Helper's CPR/FA is valid through 01/2020. The roster and children records were reviewed, several children's forms are incomplete and missing the PM286 immunization form see 809D for cited deficiencies. All adult residents and helpers have submitted or been cleared for criminal record and child abuse index clearances or exemptions.

LPA Baez reviewed physical plant, bodies of water, storage of hazardous items, Shaken Baby Syndrome, SIDS, and new Safe Sleep regulations and Licensee stated that she understands. LPA reminded Licensee that walkers, jumpers, exersaucers, and bouncers are not permitted for use in the day care.

SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Yolanda BaezTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 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: SANCHEZ, SILVIA FAMILY CHILD CARE
FACILITY NUMBER: 136610426
VISIT DATE: 05/29/2019
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Licensee was reminded that corporal punishment and smoking is not permitted at the day care. LPA Baez discussed Unusual incident reporting

IMS was discussed. Licensee is not currently providing IMS, Licensee understands that a written plan of operation needs to be submitted prior to enrolling any child that requires IMS. 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 http://www.ada.gov/childqanda.htm

Immunization law (SB792) was discussed with Licensee. Licensee understands that anyone who provides care and supervision to the children must have immunization records maintained at the facility for: pertussis, measles, and influenza. Licensee and helper are compliant with SB792.

LPA Baez discussed the new Mandated Reporter training (AB1207). LPA Baez reminded Licensee that herself and all helpers are to take the training and have the printed certificates present at the facility and available for review. Training can be located at www.mandatedreporterca.com. Licensee and helper are compliant with AB1207.

NOTICE OF SITE VISIT IS TO BE POSTED FOR 30 DAYS. LPA observed Licensee post notice of site visit. Access our updated Regulation & Forms by using our WEBSITE: http://ccld.ca.gov. Duty Line: (619) 767-2248, Open Monday thru Friday from 8AM to 5PM

SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Yolanda BaezTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019
LIC809 (FAS) - (06/04)
Page: 2 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: SANCHEZ, SILVIA FAMILY CHILD CARE
FACILITY NUMBER: 136610426
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/29/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/12/2019
Section Cited
CCR
102421
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Child's Records. Requirement not met as evidenced by children's files review. Licensee does not have complete forms for children in care. Forms that are missing for children in care include: LIC 282, LIC995A, LIC 9150, and LIC 627. This poses a potential rik to the health and safety of the clients in care.
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Licensee stated that she will have all forms in each child's folder complete and available for review by 06/12/19. Licensee stated that she will provide a written declaration of the importance of having completed forms available for review.
Type B
06/12/2019
Section Cited
CCR
102418(h)(1)
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The family day care home shall record each pupil's immunization on the California School Immunization Record, PM 286 (6/95). Requirement not met as evidenced by children's files review. Licensee does not have PM286 forms for children in care. This poses a potential rik to the health and safety of the clients in care.
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Licensee stated that she will fill the PM286 forms completely for each child in care and have proof available for review by 06/12/19. Licensee stated that she will provide a written declaration of the importance of having completed PM286 available for review.
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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: Yolanda BaezTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3