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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
376617838
Report Date:
08/03/2022
Date Signed:
08/03/2022 06:27:01 PM
Document Has Been Signed on
08/03/2022 06:27 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:
MORFIN, BELIA & ROSALBA FAMILY CHILD CARE
FACILITY NUMBER:
376617838
ADMINISTRATOR:
MORFIN, BELIA & ROSALBA
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(619) 521-1653
CITY:
SAN DIEGO
STATE:
CA
ZIP CODE:
92105
CAPACITY:
14
CENSUS:
13
DATE:
08/03/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
10:35 AM
MET WITH:
Rosalba Morfin
TIME COMPLETED:
06:30 PM
NARRATIVE
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On August 3, 2022, at 10:35 AM, Licensing Program Analyst (LPA), Luigi Gargaro, conducted an unannounced annual required inspection and met with the licensees, Rosalba Morfin. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. Thirteen (13) children and two (2) staff were present in the facility which included licensee Rosalba Mofin and her cleared and associated adult son, Isai Quezada, during this inspection. This facility is a one floor, three 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 living room, the first bedroom and the two day care bathrooms. Licensee has an alcove in front of the home which had a wall and door added to it and is now used as an additional napping room. Off limits areas are the kitchen, the laundry room and the second and third bedrooms. The kitchen is made off limits with a secured rolling screen that attaches to the kitchen counter and also contains the off limits laundry room. The second and third bedroom are made inaccessible with door locks. The licensee has an additional room behind the living room that was the former day care room. It contains one of the day care bathrooms and is currently in the process of being remodeled. The room is not being used for day care and is just used as a pass through area to get to the back yard. The room has some tools and other items that need to be removed to make it child proofed. As there have been multiple changes to the for use and off limits areas, licensee will submit a new sketch that reflects the current day care set up.
The fire extinguisher, smoke detector, and carbon monoxide detector met requirements. Most hazardous items were inaccessible to children. The licensee has toys, play equipment and materials available. The home has a fenced back and side yard available for outdoor activities. When analyst arrived, the day care children were involved in water activities in the backyard of the home with a wading pool and water tables.
The children were appropriately supervised while using these portable water features and licensee's helper son states the portable equipment is emptied whenever the children are done playing with the equipment. Licensee has no other types of bodies of water in the home besides these portable water features. The backyard has a mini trampoline that licensee understands must only be used for the ages listed on the equipment and strictly following the manufacturer's guidelines. Licensee was advised the manufacturer's use guide must be available at all times for review.
SUPERVISOR'S NAME:
Jason Garay
TELEPHONE:
(619) 767-2250
LICENSING EVALUATOR NAME:
Luigi Gargaro
TELEPHONE:
(619) 767-2229
LICENSING EVALUATOR SIGNATURE:
DATE:
08/03/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/03/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
Page:
1
of
11
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:
MORFIN, BELIA & ROSALBA FAMILY CHILD CARE
FACILITY NUMBER:
376617838
VISIT DATE:
08/03/2022
NARRATIVE
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The facility has built a newly constructed home in what was formerly its back yard. The home is separately addressed as 3614 45th Street. The home is currently made cursorily inaccessible with licensee supervision and a furniture barricade that blocks the path leading to the new home's side entrance door. Analyst discussed the installation of secured gating with the licensee and her son to make the second home inaccessible to day care children. Analyst will discuss the home situation with his manager and advise licensee of additional requirements going forward. 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.
Licensee’s First Aid and CPR certifications expire on April of 2024. Her assistant son's expire on May of 2023. Licensee and her son had proof of required immunizations available during today's visit. Licensee and assistant son do not have current completed Mandated Reporter Training certifications. Licensee does not have a fire and earthquake drill log. 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 were not free from all loose articles and objects. The provider does physically checks on sleeping infants every 15 minutes. An Individual Infant Sleeping Plan [LIC 9227 (3/20)] is not 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
SUPERVISOR'S NAME:
Jason Garay
TELEPHONE:
(619) 767-2250
LICENSING EVALUATOR NAME:
Luigi Gargaro
TELEPHONE:
(619) 767-2229
LICENSING EVALUATOR SIGNATURE:
DATE:
08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/03/2022
LIC809
(FAS) - (06/04)
Page:
10
of
11
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:
MORFIN, BELIA & ROSALBA FAMILY CHILD CARE
FACILITY NUMBER:
376617838
VISIT DATE:
08/03/2022
NARRATIVE
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Incidental Medical services (IMS) policy was discussed. 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
.
Eleven type B violations California Code of Regulations, (Title 22, Division 12 & Chapter 3), are 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:
08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/03/2022
LIC809
(FAS) - (06/04)
Page:
11
of
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Document Has Been Signed on
08/03/2022 06:27 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:
MORFIN, BELIA & ROSALBA FAMILY CHILD CARE
FACILITY NUMBER:
376617838
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
08/03/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
Plan of Correction
1
2
3
4
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:
08/03/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/03/2022
LIC809
(FAS) - (06/04)
Page:
2
of
11
Document Has Been Signed on
08/03/2022 06:27 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:
MORFIN, BELIA & ROSALBA FAMILY CHILD CARE
FACILITY NUMBER:
376617838
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
08/03/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)1
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child care home.
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 she has not conducted fire and disaster drills within the past six months or documented them which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date:
08/08/2022
Plan of Correction
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2
3
4
Licensee states she will conduct fire and disaster drills and then send analyst a copy of the log showing their completion to him by 08/08/22 to complete the corrections.
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:
08/03/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/03/2022
LIC809
(FAS) - (06/04)
Page:
3
of
11
Document Has Been Signed on
08/03/2022 06:27 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:
MORFIN, BELIA & ROSALBA FAMILY CHILD CARE
FACILITY NUMBER:
376617838
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
08/03/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(10)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (10) A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code Sections 1596.846(b) and (c).
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above as she had a disallowed baby bouncer in the day care which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date:
08/03/2022
Plan of Correction
1
2
3
4
Licensee corrected the deficiency today with removal of the bouncer to an off limits area of the home.
Type B
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on analyst observation, the licensee did not comply with the section cited above as the playpen she uses for the infant in care had a blanket and pillow in it which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date:
08/03/2022
Plan of Correction
1
2
3
4
Licensee corrected the deficiency during the visit by removing the pillow and blanket from the playpen and placing a fitted sheet only on the mattress. Licensee understands that there should never be any loose objects in playpens from this point forward.
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:
08/03/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/03/2022
LIC809
(FAS) - (06/04)
Page:
4
of
11
Document Has Been Signed on
08/03/2022 06:27 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:
MORFIN, BELIA & ROSALBA FAMILY CHILD CARE
FACILITY NUMBER:
376617838
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
08/03/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(A)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following: Labored breathing.
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 she is not keeping a safe sleep log for the two enrolled infants which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date:
08/15/2022
Plan of Correction
1
2
3
4
Licensee was given a blank copy of a safe sleep log and will begin maintining sleep logs for infants in care. Licensee will send a copy of the completed logs for both infants for the period from 08/04/22 to 08/12/22 and submit a copy of those records to analyst by 08/15/22 to complete the correction.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
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 she and her assistant son, Isai Quezada, did not have current Mandated Reporter Certifications which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date:
09/05/2022
Plan of Correction
1
2
3
4
The licensee and her assistant stated that they will complete the online Mandated Reporter Traning at www.mandatedreporterca.com and submit copies of their completion certificates to analyst by 09/05/22 to complete the correction.
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:
08/03/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/03/2022
LIC809
(FAS) - (06/04)
Page:
5
of
11
Document Has Been Signed on
08/03/2022 06:27 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:
MORFIN, BELIA & ROSALBA FAMILY CHILD CARE
FACILITY NUMBER:
376617838
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
08/03/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.3(a)(2)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (2) Room additions to the family child care home.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, analyst found that the licensee did not comply with the section cited above as a new home was constructed in the back yard of current day care home which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date:
08/08/2022
Plan of Correction
1
2
3
4
Licensee states she will submit a new facility sketch depicting the new home on an updated yard sketch and also submit a statement to analyst on how they will make the day care yard temporarily and permanently inaccessible to the day care children by 08/08/22.
Type B
Section Cited
CCR
102416.3(a)(6)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (6) Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on analyst observation and record review, the licensee did not comply with the section cited above as the previously off limits first bedroom was made into a for use day care room and the previous day care playroom is now only a pass through room to outdoors which poses/posed a potential health, safety or personal rights risk to chldren in care.
POC Due Date:
08/08/2022
Plan of Correction
1
2
3
4
Licensee states she will submit a new facility sketch that shows all the for use and off limits areas to analyst by 08/08/22 to complete the correction.
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:
08/03/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/03/2022
LIC809
(FAS) - (06/04)
Page:
6
of
11
Document Has Been Signed on
08/03/2022 06:27 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:
MORFIN, BELIA & ROSALBA FAMILY CHILD CARE
FACILITY NUMBER:
376617838
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
08/03/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(g)(1)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. (1) This requirement includes updating each child's PM 286 (6/95) when the child is due to receive required immunizations after enrollment in the family day care home.
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 children #1-3 and #7-10 did not have immunization records in their files which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date:
08/03/2022
Plan of Correction
1
2
3
4
Licensee contacted parents and had them bring records for all children who needed them and transferred them to blue cards during visit to complete the correction
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.
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 she did not have a roster of children in care on file which poses/posed a potential health, safety or personal rights risk to chldren in care.
POC Due Date:
08/03/2022
Plan of Correction
1
2
3
4
Licensee corrected the deficiency today by completing a roster during the visit.
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:
08/03/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/03/2022
LIC809
(FAS) - (06/04)
Page:
7
of
11
Document Has Been Signed on
08/03/2022 06:27 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:
MORFIN, BELIA & ROSALBA FAMILY CHILD CARE
FACILITY NUMBER:
376617838
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
08/03/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.
This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on record review, the licensee did not comply with the section cited above as the one infant under 12 months of age that she has in care does not have an Individual Infant Sleeping plan completed for him which poses/posed a potential health, safety or personal rights risk to the child in care.
POC Due Date:
08/08/2022
Plan of Correction
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2
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4
Analyst printed out and provided licensee with a blank Individual Infant Sleeping Plan for today.
Licensee states that she will have the parent complete the form and send analyst a copy of it by 08/08/22 to complete the correction.
Section Cited
Deficient Practice Statement
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2
3
4
POC Due Date:
Plan of Correction
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2
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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:
08/03/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/03/2022
LIC809
(FAS) - (06/04)
Page:
8
of
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