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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376617485
Report Date: 02/23/2023
Date Signed: 02/23/2023 04:06:06 PM


Document Has Been Signed on 02/23/2023 04:06 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:ACOSTA, ALMA FAMILY CHILD CAREFACILITY NUMBER:
376617485
ADMINISTRATOR:ALMA ACOSTAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 280-1515
CITY:SAN DIEGOSTATE: CAZIP CODE:
92115
CAPACITY:14CENSUS: 4DATE:
02/23/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Alma AcostaTIME COMPLETED:
03:09 PM
NARRATIVE
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 On 1/23/23 at 2:30 PM Licensing Program Analyst Annette Sutherland (LPA) conducted case management inspection . During the home inspection, the following was observed:

An infant was sleeping in the crib with several blankets, helper removed blanket during visit. A second infant was observed sleeping in a car seat, child was removed during visit. Licensee did not have sleep logs for infants. LPA provided safe sleep regulations and sleep log information to licensee and helper.

See LIC 809D for Type A & B deficiencies.

LPA Annette Sutherland informed facility representative Alma Acosta that this report dated 2/23/23 documents 2 Type A citation(s) which shall be posted for 30 consecutive days as there is an immediate risk(s) to the health, safety, or personal rights of children in care. Also, LPA Annette Sutherland informed the facility representative Alma Acosta to provide a copy of this licensing report dated 2/23/23 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Annette SutherlandTELEPHONE: (619) 629-8751
LICENSING EVALUATOR SIGNATURE:
DATE: 02/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2023
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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Document Has Been Signed on 02/23/2023 04:06 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: ACOSTA, ALMA FAMILY CHILD CARE
FACILITY NUMBER: 376617485

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/23/2023
Section Cited

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102425 (b) INFANT SAFE SLEEP Cribs or play yards shall be free from all loose articles and objects. This requirement was not met as evidenced by....
Based on LPA observation. An infant was sleeping in a crib with multiple blankets. This poses an immediate risk to the health and safety of children in care.
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Licensee removed items from crib during visit.
Type A
02/23/2023
Section Cited

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102425 (h) Car seats shall only be used for transportation purposes and shall not be used for sleeping. This requirement was not met as evidenced by.....
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Licensee took infant out of car seat and placed her in a crib.
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Based on LPA observation. An infant was sleeping in a car seat. This poses an immediate risk to the health and safety of 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: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Annette SutherlandTELEPHONE: (619) 629-8751
LICENSING EVALUATOR SIGNATURE:
DATE: 02/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3


Document Has Been Signed on 02/23/2023 04:06 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: ACOSTA, ALMA FAMILY CHILD CARE
FACILITY NUMBER: 376617485

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/03/2023
Section Cited

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Sleep log – 102425(j)(2)
The provider shall supervise infants while they are sleeping and adhere to the following requirements: (2) The provider shall check and document the following: Labored breathing.Signs of distress which includes but is not limited to flushed skin color, increase in body temperature and restlessness.Infants up to 12 month of age who are sleeping in a position other than on their back. Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:
a. Date.
b. Infant’s name.
c. Time of each 15-minute check.This requirement was not met as evidenced by


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LIcensee stated that she checks on infants but was not aware that they needed to log the sleep. LIcensee stated she will log and send LPA proof via email to Annette.Sutehrland@dss.ca.gov by 3/3/23.
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LIcensee stated that she was not aware she needed to maintain a sleep log. This poses a potential risk to the health and safety of 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: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Annette SutherlandTELEPHONE: (619) 629-8751
LICENSING EVALUATOR SIGNATURE:
DATE: 02/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2023
LIC809 (FAS) - (06/04)
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