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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370811110
Report Date: 09/03/2019
Date Signed: 09/03/2019 05:21:10 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:HILLER, CECILIA FAMILY DAY CAREFACILITY NUMBER:
370811110
ADMINISTRATOR:HILLER, CECILIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 263-3489
CITY:SAN DIEGOSTATE: CAZIP CODE:
92102
CAPACITY:12CENSUS: 0DATE:
09/03/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
05:01 PM
MET WITH:Cecilia HillerTIME COMPLETED:
05:30 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Selina Siao and Gloria Gonzalez conducted an unannounced inspection. Upon arrival, LPAs met with licensee, her daughter/adult resident Tanya Hiller. The facility is closed for the week and no children are in care. Interviews obtained from licensee which indicated that licensee's adult grand daughter Taniah Spicer who is intellectual developmental delay resides at the home but when she turned 18, they failed to get her fingerprinted through livescan. Civil penalty of $500 will be issued today.

See LIC809D for type A citation issue:

“Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. “
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina SiaoTELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2019
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: HILLER, CECILIA FAMILY DAY CARE
FACILITY NUMBER: 370811110
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/03/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/04/2019
Section Cited

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Prior to the Department issuing a license, the applicant(s) and all adults residing in the home shall obtain a California criminal record clearance or exemption. This requirement was not met as evidence by:
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Licensee's adult grand daughter Taniah Spicer who is intellectual developmental delay does not have the required background clearances. $500 civil penalty will be assess today. This poses an immediate health and safety risk to clients 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: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina SiaoTELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:
DATE: 09/03/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/03/2019
LIC809 (FAS) - (06/04)
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