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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376618682
Report Date: 12/15/2020
Date Signed: 12/15/2020 01:28:24 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:CHAVEZ, IRENE FAMILY CHILD CAREFACILITY NUMBER:
376618682
ADMINISTRATOR:IRENE CHAVEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 507-7446
CITY:SAN DIEGOSTATE: CAZIP CODE:
92115
CAPACITY:14CENSUS: 0DATE:
12/15/2020
TYPE OF VISIT:Case Management - IncidentANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Irene ChavezTIME COMPLETED:
01:27 PM
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On 12/15/20 at 1:00 PM, Licensing Program Analyst (LPA) Keturah Lane, conducted an announced Case Management Tele-Inspection visit regarding Licensee and her husband who tested positive for COVID-19 at this facility. Due to COVID-19, a tele-inspection was conducted using FaceTime to tour the facility. Licensee Irene Chavez was present at the tele-inspection and licensee’s daughter was also present.
Census at time of report was 0 children because the facility was closed. Licensee decided to close the facility on 11/25/20 after Licensee came down with symptoms. Licensee and her husband went to get tested on 11/29/20 and both received positive results on 12/2/20. Last day children attended daycare was 11/25/20. Some of the children were not at the daycare the week of Thanksgiving. Quarantine began on 11/25/20 and was completed on 12/9/20. Licensee notified all parents by phone on Sunday 11/29/20 that facility would be closed. Census on the last day of care which was 11/25/20 was 3 children (including provider’s own grandson). Licensee was contacted by DPH on 12/9/20 at 12:30 PM and spoke with Alyssa regarding her symptoms and that when she is ready to open her family day care to call her. Facility is still closed on 12/15/20 and Licensee is planning to call DPH to see if she can reopen her facility tomorrow 12/16/20. Licensee stated she is receiving the recent PINs and information from the Department via e-mail. COVID-19 guidelines tele-visit was conducted with LPA Lane on 9/4/20.
LPA Lane will continue to follow up with Licensee on the facility's situation. LPA Lane e-mailed COVID-19 resources and guidelines for review to Licensee. LPA received facility roster from Licensee on 12/3/20. LPA advised Licensee to send in LIC624b Unusual Incident report as soon as possible. Report has been delayed due to Licensee not feeling well.
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.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Keturah LaneTELEPHONE: (619) 767-2223
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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