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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370810636
Report Date: 05/23/2023
Date Signed: 05/23/2023 02:09:04 PM


Document Has Been Signed on 05/23/2023 02:09 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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108



FACILITY NAME:DENNY, SHIRLEY FAMILY DAY CAREFACILITY NUMBER:
370810636
ADMINISTRATOR:DENNY, SHIRLEYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 264-4159
CITY:SAN DIEGOSTATE: CAZIP CODE:
92102
CAPACITY:12CENSUS: 0DATE:
05/23/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Shirley Denny, Licensee TIME COMPLETED:
02:20 PM
NARRATIVE
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On 5/23/23 at 12:25 pm Licensing Program Analyst (LPA) Daniela Huerta conducted an unannounced plan of correction (POC) inspection. The purpose of the inspection is to insure citation issued during an annual inspection on 5/10/23 were corrected. Upon arrival, LPA met with Licensee Shirley Denny and disclosed purpose of the inspection. No children in care were present, however, licensee's granddaughter, 3 great-grandchildren and daughter were present.

Based on LPAs interview with licensee, during the POC inspection for today (5/23/23), licensee's son does not have a criminal record clearance or exemption. See LIC809D for failure to correct violation cited in Civil Penalty Assessed.

LPA informed licensee that this report dated 5/23/23 documents one Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA informed the Licensee that the report dated 5/23/23 that documents any Type A citation to provide a copy to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

LPAs provided licensee, Shirley Denny 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.  Failure to comply with posting requirements shall result in an immediate civil penalty of $100. An exit interview was conducted with the Licensee, who was provided a copy of their Licensee Appeal Rights LIC 9058.
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (559) 243-4588
LICENSING EVALUATOR NAME: Daniela HuertaTELEPHONE: 619-767-2214
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2023
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 05/23/2023 02:09 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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


FACILITY NAME: DENNY, SHIRLEY FAMILY DAY CARE
FACILITY NUMBER: 370810636

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/24/2023
Section Cited
CCR
102370(d)

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Based on observation, interview and record review, the licensee did not comply with the section cited above in that (1) out of (2) persons residing in the home did not have a criminal record background clearance which poses an immediate health, safety or personal rights risk to persons in care.
Licensee stated her son has lived in the home since 05/10/2021.
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Licensee stated she will have her adult resident son, obtain a criminal background clearance via Live Scan by 05/24/2023 and send proof to CCL.

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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: Jason GarayTELEPHONE: (559) 243-4588
LICENSING EVALUATOR NAME: Daniela HuertaTELEPHONE: 619-767-2214
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2023
LIC809 (FAS) - (06/04)
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