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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376613772
Report Date: 02/04/2021
Date Signed: 02/08/2021 12:32:12 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:FELICIANO, CECILIA FAMILY CHILD CAREFACILITY NUMBER:
376613772
ADMINISTRATOR:CECILIA FELICIANOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 578-3923
CITY:SAN DIEGOSTATE: CAZIP CODE:
92126
CAPACITY:14CENSUS: DATE:
02/04/2021
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Cecilia FelicianoTIME COMPLETED:
09:45 AM
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On 1/4/21 at 9:00am , Licensing Program Analyst (LPA) Annette Sutherland, conducted an announced Case Management Tele-Inspection to follow up on a report of individuals testing positive for COVID-19 at the facility. Due to COVID-19, a tele-inspection was conducted using Zoom to tour the facility. Licensee Cecilia was present at the tele-inspection. Census at time of report was 0 children because the facility was closed. Licensee decided to close the facility on 1/29/21 after a resident in the home tested positive for COVID-19. Other individuals in the home were tested on 1/28/21 and received their positive test result on 1/29/21. It was reported to the duty worker line on 2/1/21. Licensee reported 3 additional positive Covid cases today . Licensee spoke with Gloria Chavez at DPH.

LPA Sutherland will continue to follow up with Licensee on the facility's situation. LPA received both LIC624b Unusual Incident report and roster as required. LPA provided technical assistance emailed self-Assessment Guide, Covid related posters, Provider information notice of frequently asked questions in regards to Covid 19, Safety and health guidance from the CAL OSHA.

An exit interview was conducted with the Licensee. Appeal Rights were discussed and provided. Facility was advised to post the Notice of Site Visit for 30 days. A copy of the report, appeal rights and notice of site visit will be e-mailed to the facility and Licensee was advised that acknowledgement of the receipt of the report is to be received within twenty-four hours.

No deficiencies were cited.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Annette SutherlandTELEPHONE: (619) 629-8751
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2021
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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