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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376617835
Report Date: 03/03/2020
Date Signed: 03/03/2020 03:51:25 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:CHAVEZ, SANDRA KARINA FAMILY CHILD CAREFACILITY NUMBER:
376617835
ADMINISTRATOR:CHAVEZ, SANDRA KARINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 690-5947
CITY:SAN DIEGOSTATE: CAZIP CODE:
92154
CAPACITY:14CENSUS: 11DATE:
03/03/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Sandra ChavezTIME COMPLETED:
04:00 PM
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An unannounced random inspection was conducted today. Upon arrival LPA Castellon observed 11 children in care with the licensee. Licensee Sandra Chavez was present along with her two adult children. LPA conducted a tour of the home to ensure the health and safety of children. Licensee is using the following areas for daycare: living room, kitchen/dining area day-care room, and hallway bathroom. Bedrooms #1, #2, and #3 are off limits.
Mrs. Chavez states that she does not maintain weapons in the home. There are no bodies of water on the premises. All cleaners, toxics, medications and other hazardous substances are inaccessible to children in care via latched cabinets in the kitchen and hallway bathroom. Fire extinguisher, carbon monoxide detector and smoke detectors present in the home meet State Fire Marshall standards. The home is kept clean and orderly with sufficient ventilation for safety and comfort. The home provides safe toys, play equipment and materials. The home does maintain a working telephone service.
Outdoor play area is a fully fenced backyard. The licensee maintains a current children’s roster. Emergency disaster drills are practiced and documented. The licensee and helpers have completed CPR/First Aid training, certificates are valid thru 12/20. Safe sleep was discussed on this date. Licensee was reminded to report all unusual incidents or injuries via telephone call within 24 hours and LIC624 within 7 calendar days.
Facility has not exceeded the capacity specified on the license. Appropriate ratios observed on this date All individuals subject to criminal record review have obtained criminal record clearance or exemption prior to working, residing or volunteering.

CONTINUED ON PAGE 2
SUPERVISOR'S NAME: Joe CarrascoTELEPHONE: (619) 767-2243
LICENSING EVALUATOR NAME: Adrian CastellonTELEPHONE: (619) 767-2237
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2020
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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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: CHAVEZ, SANDRA KARINA FAMILY CHILD CARE
FACILITY NUMBER: 376617835
VISIT DATE: 03/03/2020
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Incidental Medical Services (IMS) policy was discussed. Facility does not provide incidental medical services. 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

Licensees can request to be on a distribution list for the Quarterly Updates by emailing: Childcare advocatesprogram@dss.ca.gov.

Adult immunization requirement has been met. Mandated reporter training has been met..

No citations issued.

Community Care Licensing WEBSITE: http://www.ccld.ca.gov

SUPERVISOR'S NAME: Joe CarrascoTELEPHONE: (619) 767-2243
LICENSING EVALUATOR NAME: Adrian CastellonTELEPHONE: (619) 767-2237
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2020
LIC809 (FAS) - (06/04)
Page: 2 of 2