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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376609090
Report Date: 05/20/2022
Date Signed: 05/24/2022 03:06:50 PM


Document Has Been Signed on 05/24/2022 03:06 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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108



FACILITY NAME:MIRANDA, MARTHA FAMILY CHILD CAREFACILITY NUMBER:
376609090
ADMINISTRATOR:MARTHA MIRANDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 817-5771
CITY:SAN DIEGOSTATE: CAZIP CODE:
92104
CAPACITY:14CENSUS: 0DATE:
05/20/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:40 PM
MET WITH:Martha MirandaTIME COMPLETED:
05:00 PM
NARRATIVE
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On 5/20/22 at 11:00am, LPAs Adrian Castellon and Edgar Campana conducted a complaint inspection. the purpose of the inspection is to deliver complaint findings. LPAs Castellon and Campana met with licensee Martha Miranda and discussed the purpose of the inspection. There were no day-care children present.

During the course of a complaint inspection conducted by IB Investigator Ernestina Belucco, several deficiencies were observed. This LIC809 and 809D will be used to memorialize the following deficiencies: Criminal Record Clearance (Type A) – Martha Miranda has previously been cited four times for Rosalia Vargas working without a clearance and two times for two other assistants. During the investigation, it was stated that Vargas has known Miranda and worked at the childcare for approximately 15 years. Vargas stated that her task at the childcare is housekeeping and preparing meals; Conduct Inimical – Multiple Repeat violations and being dishonest with the Department (Type A); Licensee Miranda does not reside at the address where the license has been issued (Type A); Children’s Records were not properly kept as required by licensing regulations (Type B); Children’s Roster was not available for review upon request (Type B); Childcare areas were cluttered (Type B). Please see LIC809D for deficiencies.

A copy of today's report was given to licensee Miranda. Appeals Rights were given to and discussed with licensee Miranda. Notice of Site inspection was given to licensee Miranda and posting requirement was discussed. LIC9224 Reporting Requirement was discussed on this date. Please be advised that the surrender of your license does not deprive the Department of its authority to institute or continue an administrative action against you.
SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Adrian CastellonTELEPHONE: (619) 767-2237
LICENSING EVALUATOR SIGNATURE:
DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/20/2022
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 5


Document Has Been Signed on 05/24/2022 03:06 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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108


FACILITY NAME: MIRANDA, MARTHA FAMILY CHILD CARE
FACILITY NUMBER: 376609090

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
05/20/2022
Section Cited

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102370(d)(1) 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, residing, or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department.
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Licensee Miranda will ensure that all persons working at the facility are fingerprint cleared prior to working at the licensed facility.
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This requirement was not met as evidenced by: licensee Miranda did not ensure that Rosalia Vargas was fingerprint cleared prior to working at the licensed facility. Rosalia Vargas working as an assistant and providing care without required clearances. This poses an immediate threat to children in care.
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Request Denied
Type A
05/20/2022
Section Cited

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1596.885(c) Denial, suspension or revocation of license, registration, or special permits; grounds. (c) Conduct which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of this state.
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Licensee Miranda will follow all licensing rules and regulations and will contact the licensing office should she have questions or concerns.
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This requirement was not met as evidenced by licensee Miranda's repeated licensing violations and dishonesty towards the Department during the investigation. This poses an immediate threat to 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: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Adrian CastellonTELEPHONE: (619) 767-2237
LICENSING EVALUATOR SIGNATURE:
DATE: 05/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/20/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/24/2022 03:06 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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108


FACILITY NAME: MIRANDA, MARTHA FAMILY CHILD CARE
FACILITY NUMBER: 376609090

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/20/2022
Section Cited

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102417(b) Operation of a Family Child Care Home: (b) The home shall be kept clean and orderly, with heating and ventilation for safety and comfort.
This requirement was not met as evidenced by: licensee's failure to maintain a clean and orderly day-care space. This poses a potential threat to the health and safety of children in care.
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Licensee Miranda will keep a tidy day-care space and will keep all day-care areas free of clutter and debris.
Type B
05/20/2022
Section Cited

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102417 Operation of a Family Child Care Home(g)(8): (g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to: (8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.
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Licensee will maintain all required licensing documents and will provide the documents upon request.
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This requirement was not met as evidenced by: licensee Miranda was not able to provide a current updated facility roster upon request. This could pose a threat 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: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Adrian CastellonTELEPHONE: (619) 767-2237
LICENSING EVALUATOR SIGNATURE:
DATE: 05/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/20/2022
LIC809 (FAS) - (06/04)
Page: 3 of 5


Document Has Been Signed on 05/24/2022 03:06 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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108


FACILITY NAME: MIRANDA, MARTHA FAMILY CHILD CARE
FACILITY NUMBER: 376609090

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/20/2022
Section Cited

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102417(g)(7): Operation of a Family Child Care Home: (g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to: (7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and

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Licensee Miranda will maintain all required documents and provide the documents upon request.
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location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care. This requirement was not met as evidenced by licensee Miranda could not provide the required Identification and Emergency Contact form as required by licensing regulations. This poses a potential threat to the health and safety of the 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: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Adrian CastellonTELEPHONE: (619) 767-2237
LICENSING EVALUATOR SIGNATURE:
DATE: 05/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/20/2022
LIC809 (FAS) - (06/04)
Page: 4 of 5


Document is an Amendment of Original Document on 05/26/2022 10:32 AM

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: MIRANDA, MARTHA FAMILY CHILD CARE
FACILITY NUMBER: 376609090

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/20/2022
Section Cited

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1596.78(a) “Family day care home”: (a) "Family day care home" means a home that regularly provides care, protection, and supervision for 14 or fewer children, in the provider's own home, for periods of less than 24 hours per day, while the parents or guardians are away, and is either a large family day care home or a small family
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Licensee will advise the SDCCRO of any changes to her license, including when moving out of her licensed home. Licensee will not provide care in an unlicensed home.
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day care home. This requirement was not met as evidenced by: Based on observations, interviews conducted, licensee's admission, and records reviewed, the licensee does not reside in the home, which care is being provided, which poses an immediate Health and Safety risk to 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: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Adrian CastellonTELEPHONE: (619) 767-2237
LICENSING EVALUATOR SIGNATURE:
DATE: 05/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/20/2022
LIC809 (FAS) - (06/04)
Page: 5 of 5