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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376613266
Report Date: 12/15/2020
Date Signed: 12/15/2020 04:36:24 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:NAVARRO, ELVIA FAMILY CHILD CAREFACILITY NUMBER:
376613266
ADMINISTRATOR:ELVIA NAVARROFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 434-1873
CITY:SAN DIEGOSTATE: CAZIP CODE:
92139
CAPACITY:14CENSUS: 3DATE:
12/15/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:08 PM
MET WITH:Elvia Navarro, LicenseeTIME COMPLETED:
04:21 PM
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On December 15, 2020 at 3:08 PM Licensing Program Analyst (LPA), Marie Hernandez, conducted an unannounced Tele-Conference Case Management Inspection due to the COVID -19 State of Emergency due to an incident that occurred with child #1. LPA met with the License, Elvia Navarro. The facility reports that on 12/01/2020 at 9:40 AM, the Licensee was in the kitchen cooking eggs for the children and the facility’s one year old dog was laying down in front of the stove. Child #1 was in the kitchen sitting on the stool and got down from the stool to see what the Licensee was cooking. The Licensee stated child #1 knelt down to hug the dog, lost her balance and fell onto the dog’s leg. The Licensee stated the dog reacted to child falling on his leg and scratched the child on the nose and on the head with his teeth. The Licensee stated the dog did not bite the child as Licensee did not observe any bite marks on child. Child #1 sustained an injury which required medical attention. The parent was contacted and took child to the doctors. The child received stitches on her nose and staples on her head. LPA conducted a virtual inspection of the facility and observed the dog. LPA conducted several interviews with the Licensee, several day care children and the Licensee’s children. LPA was unable to interview the child #1 in question as child no longer attends the facility. However, due to insufficient information available at this time, the incident requires further review.

LPA Marie Hernandez explained the case management incident inspection report, and the Licensee, Elvia Navarro stated it was understood. A copy of the report was emailed to the Licensee. The Licensee is advised that acknowledgement of the receipt of the report is to be received within 24 hours. NOTE on Facility Signature: SEE FILE FOR ACKNOWLEDGEMENT.
SUPERVISOR'S NAME: Joe CarrascoTELEPHONE: (619) 767-2243
LICENSING EVALUATOR NAME: Marie HernandezTELEPHONE: (619) 767-2244
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2020
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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