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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376604029
Report Date: 07/03/2019
Date Signed: 07/03/2019 04:29:19 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:GUZMAN, ELSA FAMILY CHILD CAREFACILITY NUMBER:
376604029
ADMINISTRATOR:GUZMAN, ELSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 560-1869
CITY:SAN DIEGOSTATE: CAZIP CODE:
92123
CAPACITY:14CENSUS: 9DATE:
07/03/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:05 PM
MET WITH:Elsa GuzmanTIME COMPLETED:
04:35 PM
NARRATIVE
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On 07/03/19 at 3:05 p.m. Licensing Program Analysts (LPAs) Brooke Sykora and Joelle Redding made an unannounced visit for the purpose of a Random Annual inspection. At the time of the inspection, there were nine children in care with the Licensee and her assistant, two of which were under the age of four. The facility is within ratio and capacity.

LPAs conducted a tour of the home to ensure compliance with standards established in CCR, Title 22, Division 12, Chapter 3. Hours of operation are Monday through Friday 6:00 a.m. to 6:00 p.m. The primary child care areas include: kitchen, living room, two family rooms, hallway bathroom, and the fully fenced backyard. There are no hazardous substances accessible. There are no weapons stored in the home or on the property and there are no bodies of water present. The fire extinguisher is full and of adequate size and located in the kitchen. The dual smoke and carbon monoxide detector, located in the back family room are operational. The home is clean, orderly and has adequate ventilation and heating. Licensee has provided sufficient space for the children to eat, sleep and play within the home. There is a working telephone. LPAs reviewed the facility roster and children's records for emergency information, immunizations and Notification of Parents’ Rights form. Upon record review, emergency consent for Children #2-6 and 8 were missing from the children's files. In addition, a current roster was incomplete. Licensee's pediatric CPR/First Aid certificate is valid through 05/2021. The Licensee's assistant has current CPR/First Aid through 05/2021. SIDS/Safe Sleep was discussed and Safe Sleep handouts were provided. LPAs and Licensee discussed California Megan's Law and LPA provided the following:  www.meganslaw.ca.gov. Effect of Lead Exposure handout was provided for dissemination to parents/guardians of current and future enrollees.

The facility is not currently providing Incidental Medical Services (IMS). For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided:
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Brooke SykoraTELEPHONE: (619) 767-2218
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2019
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 4
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: GUZMAN, ELSA FAMILY CHILD CARE
FACILITY NUMBER: 376604029
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/03/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/10/2019
Section Cited

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Operation of a Family Child care Home. An emergency information card shall be maintained for each child and shall include authorization for the licensee...to consent to emergency medical care.
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This requirement was not met as evidenced by:

Based on record review and interview, the Licensee failed to ensure that medical consent (LIC 627) was maintained for Children #2 through 6 and 8 (see LIC 811) which poses a potential risk to the health and safety of children 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: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Brooke SykoraTELEPHONE: (619) 767-2218
LICENSING EVALUATOR SIGNATURE:
DATE: 07/03/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/03/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4
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: GUZMAN, ELSA FAMILY CHILD CARE
FACILITY NUMBER: 376604029
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/03/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/10/2019
Section Cited

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On or before March 30, 2018, a person who...is a licensed child care provider...or employee of a licensed child day care facility shall complete the mandated reporter training...and shall complete renewal mandated reporter training every two years...
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This requirment was not met as evidenced by:

Based on record review, mandated reporter training verification was not available for present assistant which poses a potential risk to children in care.
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Type B
07/10/2019
Section Cited

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Operation of a Family Child Care Home. Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. This requirement was not met as evidenced by:
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Based on record review, the Licensee failed to retain a current roster of children which poses a potential risk to the safety of children 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: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Brooke SykoraTELEPHONE: (619) 767-2218
LICENSING EVALUATOR SIGNATURE:
DATE: 07/03/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/03/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: GUZMAN, ELSA FAMILY CHILD CARE
FACILITY NUMBER: 376604029
VISIT DATE: 07/03/2019
NARRATIVE
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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

Staff immunizations are current. All required postings were posted in a visible area. Mandated Reporter Training was completed on 04/05/18. The Licensee's assistant will need to complete the mandated reporter training. The website was provided: http://www.mandatedreporterca.com.

Licensee is reminded that walkers, exersaucers, jumpers, and bouncy seats are not permitted for use. Licensee is advised to regularly visit the Community Care Licensing WEB SITE: http://www.ccld.ca.gov/ for quarterly updates and updated regulation information.

Southern California Child Care Advocate information was provided and Applicant was encouraged to contact the advocate in order to be placed on an email list for updated regulation information. Advocate information was provided: (714) 703-2800 or childcareadvocatesprogram@dss.ca.gov.

See LIC 809-D for deficiencies.

An exit interview was conducted. A copy of this report along with the LIC809-D and appeal rights (LIC 9058) were provided. Licensee’s signature on this form acknowledges receipt of these rights.

The Notice of Site Visit (LIC 9213) was issued and must remain posted for 30 days.
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Brooke SykoraTELEPHONE: (619) 767-2218
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4