376608782-11-13-2019-20-CC-RGOU-BHVUZJ-20191113150136

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376608782
Report Date: 11/13/2019
Date Signed: 11/13/2019 03:01:53 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:	RIVAS, ROSA & FAUSTO FAMILY CHILD CARE		FACILITY NUMBER:	376608782
ADMINISTRATOR:	RIVAS, ROSA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 475-4686
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92139
CAPACITY:	14	CENSUS: 9	DATE:	11/13/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:03 PM
MET WITH:	Rosa & Fausto Rivas		TIME COMPLETED:	03:15 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	Licensing Program Analysts (LPAs) Rajani Goudreau and Martha Malane conducted an unannounced annual/random inspection. Upon arrival, LPA met with Licensee’s, Rosa & Fausto Rivas and proceeded to tour the facility. There were nine children including three infants in care. Facility is within ratio and capacity limitations. Child care operation hours are Monday through Friday, 24 hours. LPAs conducted a tour of the home/outdoor play area to ensure compliance with standards established in CCR, Title 22, Division 12, Chapter 3. Licensee has provided adequate space for the children to eat, sleep and play within the home. The home is kept is kept clean and orderly, with heating and ventilation for safety and comfort. Areas used for child care include: dining room, kitchen, bathroom #3 located in day care room, day care room on lower level of home and back yard. Off limit areas of the home include: front yard, bedrooms #1, #2, #3, bathrooms #1, #2. Off limit areas of the home are made securely inaccessible. All cleaning compounds, detergents, medications and other items which could pose a danger to children are stored where they are inaccessible to children. The fire extinguisher, smoke and carbon monoxide detector meet requirements and are operational. Children’s toys and play equipment are safe and age appropriate. Primary telephone is a land line which is operational. There are no firearms or other weapons in the home, per licensees. Licensee has all appropriate forms posted, per observation. Fenced gas fire place located in living room of home is not used. Top and the bottom of stairs are fenced. There are no bodies of water observed in or outside of the home. Outdoor play area is fenced and free of hazardous items, per LPA observation. LPA advised Licensee to provide direct supervision when children are playing outside. Children’s records and roster reviewed and complete. Pediatric CPR and First-Aid certificates for licensee, Rosa is valid through 11/2020 and licensee, Fausto is valid through 11/2020. See LIC809-C continuation page...

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2019

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: RIVAS, ROSA & FAUSTO FAMILY CHILD CARE	FACILITY NUMBER: 376608782
	VISIT DATE: 11/13/2019

NARRATIVE

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During review of facility associations at time of inspection, staff #1 (S1), was not associated to facility. LPA reviewed system and S1 finger print clearance was not active. Licensee indicated S1 has been working at the facility on and off for the past couple of years. Licensees indicated they were under the assumption S1 was cleared and associated to facility. LPA reviewed LIC9163-Request for Live Scan Services for S1 dated 01/06/09. Licensee, Fausto indicated S1 will not work in the facility until she is cleared and associated to facility. LPAs observed S1 leave facility with licensee, Fausto to obtain finger print clearance. LPA informed licensees all new adults living or working in the home must have criminal record clearance or exemptions and child abuse index clearances prior to employment or residing in the home. Licensees acknowledges understanding of requirement. Last fire/earthquake drill was conducted on 10/16/19. Licensees and S1 have met immunization requirement per SB792. In addition, Licensees have completed the AB1207 Mandated Reported Training.

LPA discussed the following with licensee: California Megan's Law, www.meganslaw.ca.gov. LPA informed licensee in order to access Child Care Licensing Regulations and Forms to visit the following website: http://ccld.ca.gov. LPA discussed the following with licensee: Child Care Advocates - (916) 654-1541, childcareadvocatesprogram@dss.ca.gov.

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

LPA discussed the following with Licensee: reporting suspected child abuse & neglect, maintain children’s records according to regulation, post all required forms, ensure that all adults living or working in home have criminal background clearances to avoid civil penalties, emergency drills conducted every 6 months, heat-related illness, child passenger law, unusual incidents and time frames, information on SIDS, shaken baby syndrome, lead poisoning effects brochure. LPA informed licensee corporal punishment, smoking, walkers, exersaucers, jumpers and bouncy seats shall never be permitted during day care operation. See LIC809-C continuation page...

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2019

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: RIVAS, ROSA & FAUSTO FAMILY CHILD CARE	FACILITY NUMBER: 376608782
	VISIT DATE: 11/13/2019

NARRATIVE

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Community Care Licensing Duty Line: (619) 767-2248, open Monday through Friday from 8:00AM to 5:00PM. LPA, Rajani Goudreau may be reached at (619) 767-2215 and at Rajani.Goudreau@dss.ca.gov.

LPA updated facility sketch at time of visit to reflect off limit areas of home.

Facility was cited one type A violation during today’s visit (see same day 809-D citations page). An exit interview was conducted with licensees. A copy of this report along with the LIC809-D page, appeal rights (LIC 9058), Acknowledgment of Receipt of Licensing Reports (LIC9224) were left at the facility. Upon receipt, licensees shall post and provide copies of current licensing reports to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility for the next 12 months. In addition, LIC9224, must be signed by parents/guardians of children currently in enrolled and to parents/guardians of children newly enrolled at the facility and placed in each child’s record for the next 12 months. LPA printed a copy of the Notice of Site Visit today. Notice of site visit shall be posted for 30 days. LPA observed licensees post Notice of Site Visit prior to exiting facility.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2019

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: RIVAS, ROSA & FAUSTO FAMILY CHILD CARE	FACILITY NUMBER: 376608782
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/13/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 11/14/2019 Section Cited	1 2 3 4 5 6 7	102370.Criminal Record Clearance. (d)-All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working…in a licensed facility:(1)-Obtain a California clearance or a criminal record exemption as required by the Department or…This requirement was not met as evidence by:
	8 9 10 11 12 13 14	during review of facility associations, S1 was not associated to facility and clearance was inactive, per review of LIS, which poses an immediate health and safety risk to children in care.	8 9 10 11 12 13 14	LPA provided licensees with the LIC9163-Request for Live Scan Services. Licensee, Fausto indicated he will take S1 to get a live scan today, 11/13/19 and provide copy of the LIC9163 reflecting live scan completion to the Department by 11/14/19. LPAs observed S1 leave facility with licensee, Fausto to obtain finger print clearance.
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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 Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Rajani Goudreau	TELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2019

LIC809 (FAS) - (06/04)

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