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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376610178
Report Date: 01/07/2020
Date Signed: 01/07/2020 04:23:21 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:CENICEROS,ALICIA FAMILY CHILD CAREFACILITY NUMBER:
376610178
ADMINISTRATOR:CENICEROS,ALICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 462-5909
CITY:NATIONAL CITYSTATE: CAZIP CODE:
91950
CAPACITY:14CENSUS: 6DATE:
01/07/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Alicia CenicerosTIME COMPLETED:
04:35 PM
NARRATIVE
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Licensing Program Analyst (LPA) Yolanda Baez, made an unannounced visit for the purpose of a annual inspection. LPA met with Licensee, Alicia Ceniceros. During this visit there were 6 children in care (6 School Age child). Licensee's adult daughter was also present at the time of the inspection and is fingerprint cleared and associated to the facility.

LPA toured the home, this is a two story, 4 bedrooms and 3 bathrooms home. The primary child care areas are the following: dining room area, the hallway bathroom, the living room, the kitchen, the entire front yard, and the back yard. The following areas are kept inaccessible with the use of locks or safety gates: 4 bedrooms and 2 bathrooms. The following items were in the day care bathroom and were accessible to the day care children and state "Keep out of the reach of children": Dove shampoo, Clorox, Act restoring anticavity flouride, Acclean, toothpaste, nail clipping set that consists of scissors and knife. There are a sufficient amount of age appropriate toys, games, and books available. The home has plenty of space for the children to eat, sleep and play, and was a comfortable temperature during this visit. The front yard is not fully fenced, used for outdoor activities, and Licensee was reminded that 100% supervision is required. The fire extinguisher is full, of regulation size, and located in the dining area. There is a fireplace on the property and it is properly screened. The smoke alarm and carbon monoxide monitor are operational. LPA Baez verified a working telephone, working email address, and all required forms are posted. There are no large bodies of water located on the property. Licensee stated that there are no firearms or ammunition on the property. LPA Baez verified that all adults living or working in the home have been fingerprint cleared and associated. LPA Baez reviewed children's files and child care roster. Child #1 is missing vaccinations on PM286 form, Child #2 is missing LIC 700, and Child #3 is missing LIC 995, LIC 627, LIC 282, and LIC 9150. LPA reminded Licensee to document the emergency drills once every 6 month. Licensee's pediatric CPR/FA certification expires on 09/2021. LPA Baez reviewed physical plant, bodies of water, storage of hazardous items, Shaken Baby Syndrome, SIDS, and new Safe Sleep regulations and Licensee stated that she understands.

SUPERVISOR'S NAME: Joe CarrascoTELEPHONE: (619) 767-2243
LICENSING EVALUATOR NAME: Yolanda BaezTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2020
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: CENICEROS,ALICIA FAMILY CHILD CARE
FACILITY NUMBER: 376610178
VISIT DATE: 01/07/2020
NARRATIVE
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LPA reminded Licensee that walkers, jumpers, exersaucers, and bouncers are not permitted for use in the day care. Licensee was reminded that corporal punishment and smoking is not permitted at the day care. LPA Baez discussed Unusual incident reporting. New CDPH 286 form for "California Pre-Kindergarten & School Immunization Record" was provided and discussed.

Incidental Medical Services (IMS) was discussed. Licensee is not currently providing IMS, Licensee understands that a written plan of operation must be submitted to CCL prior to enrolling a child that requires IMS. 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 http://www.ada.gov/childqanda.htm

Immunization law (SB792) was discussed with Licensee. Licensee understands that anyone who provides care and supervision to the children must have immunization records maintained at the facility for: pertussis, measles, and influenza. Facility is complaint with SB792.

LPA Baez discussed the Mandated Reporter training (AB1207). LPA Baez reminded Licensee that herself and all helpers are to take the training and have the printed certificates present at the facility and available for review. Training can be located at www.mandatedreporterca.com. Licensee is currently exempt from AB1207 because it is not offered in her native language, Spanish.

LPA and Licensee discussed California Megan’s Law and LPA provided: www.meganslaw.ca.gov.

Notice of Site Visit is to be posted for 30 days, LPA observed Licensee posting the Notice of Site Visit.

This report was translated in Spanish by LPA Baez and Licensee stated that she understands.

Access our updated Regulation & Forms by using our WEBSITE: http://ccld.ca.gov. Duty Line: (619) 767-2248, Open Monday through Friday, 8am - 5pm

LPA's email: yolanda.baez@dss.ca.gov AND working cell phone is (619) 929-5727.

SUPERVISOR'S NAME: Joe CarrascoTELEPHONE: (619) 767-2243
LICENSING EVALUATOR NAME: Yolanda BaezTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2020
LIC809 (FAS) - (06/04)
Page: 2 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: CENICEROS,ALICIA FAMILY CHILD CARE
FACILITY NUMBER: 376610178
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/07/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/21/2020
Section Cited

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(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.(1) This requirement includes updating each child's PM 286 (6/95) when the child is due to receive immunizations after enrollment in the family
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day care home. Requirement not met as evidenced by children's record review. Child #1 does not have an updated PM286 form and is missing documentation of several immunizations. This poses a potenetial risk to the health and safety of the clients in care.
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Type B
01/21/2020
Section Cited

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(g) The home shall be free from defects or conditions which might endanger a child. (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. Requirement not met as evidenced by facility tour. Licensee
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has the following accessible items in the day care bathroom: Dove shampoo, Clorox, Act restoring anticavity flouride, Acclean, toothpaste, nail clipping set that consists of scissors and knife. This poses a potenetial risk to the health and safety of the 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: Joe CarrascoTELEPHONE: (619) 767-2243
LICENSING EVALUATOR NAME: Yolanda BaezTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:
DATE: 01/07/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/07/2020
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: CENICEROS,ALICIA FAMILY CHILD CARE
FACILITY NUMBER: 376610178
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/07/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/21/2020
Section Cited

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(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and 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 ... Requirement not met as evidenced by
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children's file review. Child #2 is missing LIC 700. This poses a potential risk to the health and safety of the clients in care.
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Type B
01/21/2020
Section Cited

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(3) A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state. Child #3 does not have a signed and dated LIC 282 on file. Poses a potential 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: Joe CarrascoTELEPHONE: (619) 767-2243
LICENSING EVALUATOR NAME: Yolanda BaezTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:
DATE: 01/07/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/07/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4