376612556-3-6-2023-20-CC-LGAO-CPNU3Z-20230306141421

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376612556
Report Date: 03/06/2023
Date Signed: 03/06/2023 02:14:41 PM

Document Has Been Signed on 03/06/2023 02:14 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:	DOMINGUEZ, ESTHER FAMILY CHILD CARE		FACILITY NUMBER:	376612556
ADMINISTRATOR:	DOMINGUEZ, ESTHER		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 634-4222
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91913
CAPACITY:	14	CENSUS: 10	DATE:	03/06/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:			TIME COMPLETED:	02:20 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	On March 6, 2023, at 10:30 AM, Licensing Program Analyst (LPA), Luigi Gargaro, conducted an unannounced annual required inspection and met with the licensee, Esther Dominguez. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. Ten (10) children and three (3) staff, including the licensee's mother, Ernestina Escalante, and her daughter, Emily Dominguez, were present in the facility during this inspection. This facility is a one floor, four bedroom, two bathroom house. Licensee accompanied LPA inside and out of the facility during this inspection. The following areas used for child care are: the kitchen, the dining area, the living room and the day care bathroom. Off limits areas are: the four home bedrooms and the garage and are inaccessible through use of door knob covers that are installed on the handles of their respective entrance doors. The fire extinguisher, smoke detector, and carbon monoxide detector met requirements. All hazardous items were inaccessible to children. The licensee has toys, play equipment and materials available. The home has a fenced backyard available for outdoor activities. The yard contains a lower level yard that is reached from a staircase in the upper level yard. It is made inaccessible with a latching gate that is at the entrance of the staircase. The right alleyway in the yard is also off limits as it contains the licensee's personal items and equipment. It is made inaccessible with safety barricade gating that is at the alleyway entrance. The yard also contains a detached structure in it which is used as a residence for one of the adults in the home. The structure is off limits to the day care and is made that way with a locked door entrance. The home has a jacuzzi which is made inaccessible to children in care as it is in a locked and highly latched gazebo with a regulation secured cover on the jacuzzi itself. Licensee stated there are no weapons in the home. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023

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: DOMINGUEZ, ESTHER FAMILY CHILD CARE	FACILITY NUMBER: 376612556
	VISIT DATE: 03/06/2023

NARRATIVE

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Licensee’s First Aid and CPR certifications expire in October of 2023 while her two assistants present today have certifications that expire on May of 2023. Licensee has required immunizations. Licensee completed Mandated Reporter Training on 08/19/22 and her assistants have current certifications as well. Facility roster is maintained and was reviewed. The last fire and disaster drills were conducted and documented on 12/08/22. There is one crib or play yard for each infant who is unable to climb out of the crib or play yard. Cribs or play yards are free from all loose articles and objects. The provider physically checks on sleeping infants every 15 minutes. An Individual Infant Sleeping Plan [LIC 9227 (3/20)] is maintained for each infant up to 12 months of age. The provider places infants up to 12 months of age on their backs for sleeping.

LPA provided and discussed the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, and ensure that all adults residing or working in the home have criminal background clearances or exemptions. Licensee was reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers and/or similar equipment are not allowed in daycare. Licensee was also provided handouts with information regarding upcoming Safe Sleep Regulations/SIDS, Lead exposure and Shaken Baby Syndrome. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

LPA discussed and provided Licensee with the following: child care advocates email address: childcareadvocatesprogram@dss.ca.gov . In addition, for general questions or questions regarding licensing requirements contact the Child Care Licensing Duty Line at (619) 767-2248. Unusual Incident Reports may be e-mailed to: SDIncidentReports@dss.ca.gov

Incidental Medical Services (IMS) policy was discussed. Licensee stated that currently none of the children in care require any type of medication to be administered. 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.

One type B violation California Code of Regulations, (Title 22, Division 12 & Chapter 3), is being cited on the attached LIC 809-D.

An exit interview was conducted with the licensee. The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.

LPA provided notice of site visit and observed it being posted at the facility.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/06/2023 02:14 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: DOMINGUEZ, ESTHER FAMILY CHILD CARE	FACILITY NUMBER: 376612556
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.622(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above as her assistant, Ernestina Escalante, did not have proof of her MMR immunization on file at the facility which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/10/2023
	Plan of Correction
1 2 3 4	Licensee is unsure whether assistant has had MMR immunization but will contact her medical provider to confirm and if vaccinated will send a copy of the vaccination record or have Ms. Escalante obtain proof of immunation and send either to analyst by 04/10/23 or earlier to complete the correction.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023

LIC809 (FAS) - (06/04)

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