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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376611874
Report Date: 03/01/2022
Date Signed: 03/01/2022 10:28:44 AM


Document Has Been Signed on 03/01/2022 10:28 AM - 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:GURMILAN, ROSA FAMILY CHILD CAREFACILITY NUMBER:
376611874
ADMINISTRATOR:GURMILAN, ROSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 428-8942
CITY:SAN YSIDROSTATE: CAZIP CODE:
92173
CAPACITY:14CENSUS: 4DATE:
03/01/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:04 AM
MET WITH:Rosa Gurmilan TIME COMPLETED:
10:45 AM
NARRATIVE
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On 03/01/22 at 9:04 a.m., Licensing program Analyst (LPA) Rajani Goudreau conducted an unannounced case management deficiency visit. Upon arrival LPA met with licensee, Rosa Gurmilan, and proceeded to tour the facility. During the visit there were four children in care with one staff member present. In addition, licensees’ spouse was present in the home.

On January 06, 2022 under complaint control number 20-CC-20220106164549, licensee failed to report timely to the department child #1 (C1) wondering away from the family childcare home unsupervised for an estimate of 2 to10 minutes. Licensee stated, she was unaware the incident had to be reported to the department. Licensee stated she didn’t report the incident to the parents of the C1 until January 12, 2022. Reporting requirements and time frames discussed with the licensee.


During today’s visit two type B deficiencies were issued. The following reports were discussed and provided to the licensee: LIC809 and LIC809-D pages. LPA informed licensee Notice of Site Visit shall be posted for 30 days from today's date. Exit interview conducted with licensee, Rosa Gurmilan.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Rajani GoudreauTELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2022
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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Document Has Been Signed on 03/01/2022 10:28 AM - 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: GURMILAN, ROSA FAMILY CHILD CARE
FACILITY NUMBER: 376611874

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/01/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/18/2022
Section Cited

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102416.2 - Reporting Requirements. (b) - The licensee shall report to the Department …(2) - Any child absence…any child in care who wanders away from the Family Child Care Home…shall be reported even if the child is later found safe.
This requirement was not met as evidenced by:
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Based on licensee’s admission and record review, licensee did not comply with the section cited above as licensee didn’t report the incident to the department timely regarding C1 wondering away from the facility unsupervised, which poses a potential health, safety risk to the children in care.
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Plan of correction shall be submitted to the department by:03/18/22.

Type B
03/18/2022
Section Cited

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102416.2 - Reporting Requirements.(g)...requirements of Health & Safety...1597.467(a), no later than the same business day, the licensee shall notify a child's parent…the events...reported to the Department pursuant to Sections 102416.2(b) and (c)...This requirement was not met as evidenced by:
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Based on licensee’s admission and record review, licensee did not comply with the section cited above as licensee didn’t report the incident to the parents of C1 the day of the incident, which poses a potential health, safety risk to 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: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Rajani GoudreauTELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2