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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 136610539
Report Date: 09/17/2021
Date Signed: 09/17/2021 06:12:17 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:CRUZ, LETICIA FAMILY CHILD CAREFACILITY NUMBER:
136610539
ADMINISTRATOR:LETICIA CRUZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 562-6164
CITY:CALEXICOSTATE: CAZIP CODE:
92231
CAPACITY:14CENSUS: 11DATE:
09/17/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Leticia CruzTIME COMPLETED:
06:30 PM
NARRATIVE
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On 9/17/2021 at 3:30 pm, Licensing Program Analysts (LPAs), Gloria Gonzalez and Martha Malane conducted an unannounced Plan of Correction (POC) inspection at the facility. Purpose of this inspection is to ensure citations issued during an annual inspection dated 9/9/2021 were corrected and to amend the report dated 9/9/21. Upon arrival, LPAs met with Licensee, Leticia Cruz and proceeded to tour the facility.

There were eleven (11) children, including two (2) infants and two (2) staff during today’s inspection. LPAs observed capacity to be within the limitations set forth on the license.

The following citations issued on 9/9/21 were corrected as follows:

LPA confirmed a criminal background clearance for Adult #1 is associated to this facility.

Licensee submitted proof of First Aid & CPR for Adult #1 on 9/11/21.

Personnel records for Adult #1 shows proof of Immunizations (MMR, TDAP, and FLU).

Licensee was found to be within capacity, however licensee did not provide written confirmation to parents advising they are no longer enrolled, ensuring the ability to be within capacity. Licensee states she will submit the parent letter to Licensing by 9/20/21.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Gloria GonzalezTELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
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: CRUZ, LETICIA FAMILY CHILD CARE
FACILITY NUMBER: 136610539
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/17/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/20/2021
Section Cited

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Operation of a Family Child Care Home. All licensees shall ensure the inaccessibility of pools.....gates shall swing away from the pool, self-close and have a self-latching device located no more than six inches from the top of the gate…This requirement was not met as evidenced by:
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Based on observation, LPA observed the pool gate does not self-close or self-latch, the licensee did not ensure the pool gate self-latches or self-closes which poses an immediate Health and Safety risk to persons in care.
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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: Gloria GonzalezTELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:
DATE: 09/17/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/17/2021
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: CRUZ, LETICIA FAMILY CHILD CARE
FACILITY NUMBER: 136610539
VISIT DATE: 09/17/2021
NARRATIVE
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The following citations issued on 9/9/21 have not been corrected:

The citation issued on 9/9/21 for the pool gate not self-latching was not corrected by the plan of correction date of 9/15/21. A civil penalty in the amount of $300.00 was assessed as cited on the attached 809D.

The following citation is still pending for Adult #1 for negative tuberculosis test and which is due 9/22/21.

Licensee stated she will submit video of the inside of the pool house located behind the pool to Licensing by 9/20/21.

California Code of Regulations, (Title 22, Division 12 & Chapter 3), are being cited on the attached LIC 809-D.

LPAs provided Licensee, Leticia Cruz with the Notice of Site Visit – LIC 9213, which is to be posted for thirty (30) days. LPA observed form LIC 9213 posted on the bulletin board at the entrance. An exit interview was conducted with the licensee, who was provided a copy of their Licensee Rights (LIC 9058 1/16). Their signature on this form acknowledges receipt of these rights.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Gloria GonzalezTELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3