370810554-7-28-2021-20-CC-MHEZ-C5CQXT-20210728123404

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 370810554
Report Date: 07/28/2021
Date Signed: 07/28/2021 12:34:09 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:	CUMPLIDO, SANDRA FAMILY CHILD CARE		FACILITY NUMBER:	370810554
ADMINISTRATOR:	SANDRA CUMPLIDO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 370-0563
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91911
CAPACITY:	14	CENSUS: 9	DATE:	07/28/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:20 AM
MET WITH:	Sandra Cumplido, Licensee		TIME COMPLETED:	12:33 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On July 28, 2021, at 11:20 AM, Licensing Program Analyst (LPA), Marie Hernandez conducted an unannounced Annual Required Inspection and met with the Licensee, Sandra Cumplido. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. During the inspection, there were nine children with the Licensee and the adult helper, Elizabeth Gaytan. This facility is a one story, three bedroom, and two bathroom home. The Licensee accompanied LPA inside and out of the facility during this inspection. The following areas are used for child care are: The dinning room, living room , hallway bathroom and backyard. The off limit areas are the bedrooms and kitchen. The off limits areas are inaccessible through use of a child proof safety gate and child proof door knobs. The fire extinguisher, smoke detector, and carbon monoxide detector met requirements. All hazardous items were inaccessible to children. The storage area for poisons is locked. The licensee has toys, play equipment and materials available. No bodies of water observed on the premises during the inspection. The 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 a criminal record and child abuse clearances or exemptions. Licensee’s First Aid and CPR certifications expired on 05/2023. The Licensee and the adult helper, Elizabeth have the required immunization's. The Licensee's Mandated Reporter certification expires on 01/27/2023. The mandated reporter certification must be renewed every two years prior to expiration. The Licensee conducted the fire/disaster drill on 07/07/2021. LPA discussed and provided the Safe Sleep handouts including the Individual Infant Sleeping Plan [LIC 9227 (3/20)]. The Licensee stated it is understood. LPA reviewed the documentation of infant fifteen minute checks. LPA 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 day-care. 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: Cynthia Gray	TELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Marie Hernandez	TELEPHONE: (619) 767-2244
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021

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: CUMPLIDO, SANDRA FAMILY CHILD CARE	FACILITY NUMBER: 370810554
	VISIT DATE: 07/28/2021

NARRATIVE

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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.

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.

No deficiency cited today. An exit interview was conducted with the licensee. The licensee was provided a copy of the report and the notice of site visit. LPA provided notice of site visit, and observed it being posted at the facility.

SUPERVISOR'S NAME: Cynthia Gray	TELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Marie Hernandez	TELEPHONE: (619) 767-2244
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021

LIC809 (FAS) - (06/04)

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