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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600278
Report Date: 12/18/2019
Date Signed: 12/18/2019 12:00:04 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:MAAC GOSNELLFACILITY NUMBER:
376600278
ADMINISTRATOR:CLARIBEL ZORRILLAFACILITY TYPE:
850
ADDRESS:139 GOSNELL WAYTELEPHONE:
(760) 736-3066
CITY:SAN MARCOSSTATE: CAZIP CODE:
92069
CAPACITY:112CENSUS: 93DATE:
12/18/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:11 AM
MET WITH:Claribel ZorrillaTIME COMPLETED:
12:15 PM
NARRATIVE
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Licensing Program Analyst’s (LPA’s) Leilani Curtis and Selina Siao conducted an unannounced case management inspection. Upon arrival LPA's met with the Assistant Director Jacquelyn Rodrigues Biskupski and proceeded to tour the facility. Also present were a total of 93 children. Appropriate teacher and child ratios were observed. At 11:00 a.m. LPA's met with the Center Director Claribel Zorrilla.

On 11/12/2019, LPA's conducted an annual inspection and observed staff Mayra Chavez at the facility without being associated to this facility. On 11/13/2019, the facility submitted a Criminal Background Clearance Transfer Request for Mayra Chavez to the Department. During today's inspection substitute teacher Ana Hernandez was observed working in the facility without being associated to the facility. A Civil Penalty of $200 is being assessed today.

See LIC809D for cited deficiency. The Director was provided a copy of their appeal rights (LIC 9058 01/16) and her signature on this form acknowledges receipt of these rights. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS. LPA's observed Licensee post notice of site visit.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, 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. A copy of the Fact Sheet - AB 633 Child Care Parent Notification Requirements and a copy of LIC 9224 was given to licensee.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace CurtisTELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2019
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: MAAC GOSNELL
FACILITY NUMBER: 376600278
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/18/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/19/2019
Section Cited

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Criminal Record Clearance: (e)All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:(2) Request a transfer of a criminal record clearance as specified in Section 101170(f). This requirement was not met as evidenced by:
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On 11/12/2019, staff Mayra Chavez's fingerprints were not associated to the facility. On 12/18/2019 staff member Ana Hernandez's fingerprints were not associated to the facility. A civil penalty of $200 is assessed today. This is an immediate health and safety risk to children in care.
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The Director stated that she will not have staff start working until a copy of the fingerprint clearance is in the staff member's file.

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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: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace CurtisTELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:
DATE: 12/18/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/18/2019
LIC809 (FAS) - (06/04)
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