376618696-5-12-2022-10-CC-LMAZ-CECW4X-20220512165814

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376618696
Report Date: 05/12/2022
Date Signed: 05/12/2022 04:58:46 PM

Document Has Been Signed on 05/12/2022 04:58 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME:	SANCHEZ, HILDA FAMILY CHILD CARE		FACILITY NUMBER:	376618696
ADMINISTRATOR:	HILDA SANCHEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(760) 532-8403
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92027
CAPACITY:	14	CENSUS: 8	DATE:	05/12/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Esmeralda Benavidez, Licensee's Daughter		TIME COMPLETED:	05:15 PM

NARRATIVE

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On date and time listed, Licensing Program Analyst (LPA) Linda Almaraz arrived at the facility to conduct an annual inspection as part of a compliance review. LPA toured the facility, inside and out, records were reviewed, and the following was observed and/or discussed:

· Normal days and hours of operation are: Monday through Friday from 6AM-5:30PM

· Off-limit areas include: Living room, all rooms, second restroom and garage.

· The facility is not operating within the licensed capacity and appropriate ratios

· There was not appropriate supervision during this inspection

· A working telephone is present and the current number is on file

· Appropriate fire extinguisher, smoke detector and carbon monoxide detector present and were tested by the Licensee's daughter during this inspection.

· Fireplace in the home is inaccessible to children in off-limit area

· Hazardous items were not stored inaccessible to children

· Toxins were not locked

· Weapons are not present. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations

· Clean, safe and age appropriate toys

(Continued on an LIC-9099C)

SUPERVISOR'S NAME: Carlos Martinez	TELEPHONE: (951) 805-5739
LICENSING EVALUATOR NAME: Linda M Almaraz	TELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: SANCHEZ, HILDA FAMILY CHILD CARE	FACILITY NUMBER: 376618696
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/12/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

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	During the visit LPA observed prescription medication in the kitchen counter, a knife in the counter, a drawer with knives which was unlocked, an unlocked kitchen cabinet at the same height of the children present with clorox and a floor cleaning solution, and unlocked bathroom cleaners in the bathroom all accesible to the children, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 05/13/2022
	Plan of Correction
1 2 3 4	Licensee will remove and make inaccesible all poisons, detergents, medication, cleaning compounds, knives and items which pose a danger to the children in care. Licensee will send pictures to LPA via email by POC due date.

Type A

Section Cited

CCR

102370(d)(1)

Criminal Record Clearance

(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	The Licensee's daughter who moved into the home about 2 years ago and was assisting with the children during today's visit did not have a criminal background clearance, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 05/13/2022
	Plan of Correction
1 2 3 4	Licensee will have her daughter Esmeralda Benavidez fingerprinted immediately and any other individuals living in the home who are over 18 years of age. Licensee will send proof the process has been initiated by POC due date.

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: Carlos Martinez	TELEPHONE: (951) 805-5739
LICENSING EVALUATOR NAME: Linda M Almaraz	TELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: SANCHEZ, HILDA FAMILY CHILD CARE	FACILITY NUMBER: 376618696
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/12/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102416.5(e)

Staffing Ratio and Capacity

(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	The Licensee was not present at the home and her staff did not have any records for qualifications. During the visit, there was 4 infants and 4 children under 5 years of age, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 05/13/2022
	Plan of Correction
1 2 3 4	Licensee will make sure she is within staffing and ratio capacity at all times. A written and signed statement will be send to LPA by POC due date stating she will abide by the CCR stated above.

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: Carlos Martinez	TELEPHONE: (951) 805-5739
LICENSING EVALUATOR NAME: Linda M Almaraz	TELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: SANCHEZ, HILDA FAMILY CHILD CARE	FACILITY NUMBER: 376618696
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/12/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(9)(A)

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. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	The facility does not have record of fire and disaster drills conducted and per staff they do not practice drills, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/02/2022
	Plan of Correction
1 2 3 4	Licensee shall ensure fire and disaster drills are conducted and send LPA proof of at least 1 drill conducted by POC due date.

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	LPA observed a baby walker in the home, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/02/2022
	Plan of Correction
1 2 3 4	Licensee shall ensure there are no baby walkers in the home and are not being used. Licensee will send a sign written statement stating she will ensure walkers are not being used by POC due date.

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: Carlos Martinez	TELEPHONE: (951) 805-5739
LICENSING EVALUATOR NAME: Linda M Almaraz	TELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: SANCHEZ, HILDA FAMILY CHILD CARE	FACILITY NUMBER: 376618696
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/12/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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	During todays visit the crib and play yard had blankets and toys, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/02/2022
	Plan of Correction
1 2 3 4	Licensee will ensure all cribs and play yards are free from any loose articles and objects at all times.

Type B

Section Cited

CCR

102417(a)

Operation of A Family Child Care Home

(a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	The Licensee left out of the country to Mexico, did not notify the department or leave a qualifying staff in charge, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/02/2022
	Plan of Correction
1 2 3 4	Licensee shall ensure in the event of an emergency where she is not present at the facility, a qualifying staff is present at all times. Licensee will create a plan on how and who would be in charge. Plan will be submitted to LPA by POC due date

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: Carlos Martinez	TELEPHONE: (951) 805-5739
LICENSING EVALUATOR NAME: Linda M Almaraz	TELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: SANCHEZ, HILDA FAMILY CHILD CARE	FACILITY NUMBER: 376618696
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/12/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(i)

Infant Safe Sleep

If an infant falls asleep before being placed in a crib or play yard, the provider shall move the infant to a crib or play yard as soon as possible. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	LPA Almaraz observed the Licensee's daughter placing a child who was asleep in a bouncer, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/02/2022
	Plan of Correction
1 2 3 4	Licensee shall ensure children are being placed on cribs or play yards. Depending on age the Licensee shall ensure mats or cotts are available for children.

Type B

Section Cited

CCR

102425(j)(1)

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	During the visit, LPA observed staff did not check the sleeping infants every 15 minutes. Per staff they do not check the infants because they are near them in the room, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/02/2022
	Plan of Correction
1 2 3 4	Licensee shall ensure all infants are checked every 15 minutes during their sleep and train all staff on the requirement. Licensee will send the log created to ensure the 15 minute checks to LPA by POC due date and start conducting checks immediately.

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: Carlos Martinez	TELEPHONE: (951) 805-5739
LICENSING EVALUATOR NAME: Linda M Almaraz	TELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: SANCHEZ, HILDA FAMILY CHILD CARE	FACILITY NUMBER: 376618696
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/12/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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	Licensee did not have record of mandated reporter training for herself or staff, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/02/2022
	Plan of Correction
1 2 3 4	Licensee will submit proof of mandated reporting training for herself and all staff by POC due date.

Type B

Section Cited

HSC

1597.622(c)

Administration of Child Day Care Licensing

(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	The Licensee did not have immunization records for staff or herself, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/02/2022
	Plan of Correction
1 2 3 4	Licensee shall submit proof of immunization for all staff by POC due date and ensure its maintain in the home at all times.

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: Carlos Martinez	TELEPHONE: (951) 805-5739
LICENSING EVALUATOR NAME: Linda M Almaraz	TELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: SANCHEZ, HILDA FAMILY CHILD CARE	FACILITY NUMBER: 376618696
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/12/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Licensee was not present at the facility and was out of the country and wont be returning until a week from now. The only qualifying staff did not have proof of completing CRP & First Aid Training, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/02/2022
	Plan of Correction
1 2 3 4	Licensee will submit proof of preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid for all staff left alone with children and herself by POC due date.

Type B

Section Cited

CCR

102416.1(a)

Personnel Records

(a) Personnel records shall be maintained on each employee and shall contain the following information: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Per Licensee and her daughter, they have no records for staff, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/02/2022
	Plan of Correction
1 2 3 4	Licensee will have complete full files for all staff and herself by POC due date.

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: Carlos Martinez	TELEPHONE: (951) 805-5739
LICENSING EVALUATOR NAME: Linda M Almaraz	TELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: SANCHEZ, HILDA FAMILY CHILD CARE	FACILITY NUMBER: 376618696
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/12/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416.2(a)(2)

Reporting Requirements

(a) The licensee shall report the following information the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm). (2) Any change in household composition including adults moving in or out of the home and anyone living in the home who reaches his or her 18th birthday. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	The Licensee's daughter who was assisting with the care and supervision of the children moved in about 2 years ago, and 2 of her daughters moved out over 2 years ago which were never reported to the Department, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/02/2022
	Plan of Correction
1 2 3 4	Licensee will submit a revised application with the most current information and will send revised forms upon any changes. Application shall be submitted by POC due date.

Type B

Section Cited

HSC

1597.622(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. 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 by not having a records of immunization for each staff which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/02/2022
	Plan of Correction
1 2 3 4	Licensee shall ensure all staff have immunization prior to starting their employment at the home.

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: Carlos Martinez	TELEPHONE: (951) 805-5739
LICENSING EVALUATOR NAME: Linda M Almaraz	TELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

LIC809 (FAS) - (06/04)

Page: 9 of 21

Document Has Been Signed on 05/12/2022 04:58 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: SANCHEZ, HILDA FAMILY CHILD CARE	FACILITY NUMBER: 376618696
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/12/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(7)

Operation of A Family Child Care Home

(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	The Licensee did not have a an emergency information card for each child or a medical consent form. During the visit the daughter and staff stated they did not have numbers to contact the parents. The Licensee's daughter had to contact her via phone and get each parents number to have the children be picked up, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/02/2022
	Plan of Correction
1 2 3 4	Licensee shall ensure all children have an emergency information card on file by POC due date.

Type B

Section Cited

CCR

102418(a)

Immunizations

(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	The Licensee did not have records of immunization for each child enrolled and present at the home, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/02/2022
	Plan of Correction
1 2 3 4	Licensee will ensure all immunization records for each child are at the facility by POC due date.

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: Carlos Martinez	TELEPHONE: (951) 805-5739
LICENSING EVALUATOR NAME: Linda M Almaraz	TELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

LIC809 (FAS) - (06/04)

Page: 10 of 21

Document Has Been Signed on 05/12/2022 04:58 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: SANCHEZ, HILDA FAMILY CHILD CARE	FACILITY NUMBER: 376618696
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/12/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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	The Licensee does not have a children's roster which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/02/2022
	Plan of Correction
1 2 3 4	Licensee shall create a roster and send to LPA by POC due date.

Type B

Section Cited

CCR

102417(m)(3)

Operation of A Family Child Care Home

(3) A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	The Licensee did not have a signed affadavit by each parent informing them of the facilities liability insurance status, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/02/2022
	Plan of Correction
1 2 3 4	Licensee shall ensure each child has an affadavit on file of insurance liability status by POC due date.

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: Carlos Martinez	TELEPHONE: (951) 805-5739
LICENSING EVALUATOR NAME: Linda M Almaraz	TELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

LIC809 (FAS) - (06/04)

Page: 11 of 21

Document Has Been Signed on 05/12/2022 04:58 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: SANCHEZ, HILDA FAMILY CHILD CARE	FACILITY NUMBER: 376618696
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/12/2022

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
1 2 3 4	The Licensee did not have a sleeping plan for an infant who was 5 months, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/02/2022
	Plan of Correction
1 2 3 4	Licensee will complete a sleeping log prior to the child returning and ensure all required children have one.

Type B

Section Cited

CCR

102425(j)(2)(D)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	The Licensee did not have records of sleeping logs for the current infants or the infants who aged out, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/02/2022
	Plan of Correction
1 2 3 4	Licensee shall ensure all required children have a sleeping log and the files remain in the chil's file until 3 years after not attending.

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: Carlos Martinez	TELEPHONE: (951) 805-5739
LICENSING EVALUATOR NAME: Linda M Almaraz	TELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

LIC809 (FAS) - (06/04)

Page: 12 of 21

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: SANCHEZ, HILDA FAMILY CHILD CARE	FACILITY NUMBER: 376618696
	VISIT DATE: 05/12/2022

NARRATIVE

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· The facility does not have a current roster on file

· Facility Sketch, Emergency Disaster Plan and Notification of Parent’s Rights poster are posted

· There is no documentation of fire and disaster drills

· No bodies of water at this time. Licensee understands all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly covered or fenced per Title 22 Regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position.

· Verification of control of property on file

· There is no Children’s records

· There is no Employee’s records

· Licensee and staff did not have Mandated Reporter Training completed

· Pediatric CPR and First Aid Card expire on 7/2018

· Resident and staff records were not reviewed and all adults who require caregiver background checks did not have all required clearances and/or exemptions.

The licensee's daughter confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

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. (Continued on an LIC9099-C)

SUPERVISOR'S NAME: Carlos Martinez	TELEPHONE: (951) 805-5739
LICENSING EVALUATOR NAME: Linda M Almaraz	TELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

LIC809 (FAS) - (06/04)

Page: 19 of 21

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: SANCHEZ, HILDA FAMILY CHILD CARE	FACILITY NUMBER: 376618696
	VISIT DATE: 05/12/2022

NARRATIVE

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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

The Licensee was informed of their reporting requirements and was provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO10@dss.ca.gov

The Licensee can submit transfer forms to associate new individuals or to disassociate someone from the facility at: Associations_Disassociations858@dss.ca.gov

LPA discussed the safe sleep regulations with the Licensee's daughter/ facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Licensee's daughter was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Go to the licensing webpage www.ccld.ca.gov, and click on the “Receive Important Updates” located on the right side of the page, immediately above the Quick Links. One can add their email address and choose which program(s) they wish to receive Provider Information Notices (PIN) for.

(Continued on an LIC809-C)

SUPERVISOR'S NAME: Carlos Martinez	TELEPHONE: (951) 805-5739
LICENSING EVALUATOR NAME: Linda M Almaraz	TELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

LIC809 (FAS) - (06/04)

Page: 20 of 21

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: SANCHEZ, HILDA FAMILY CHILD CARE	FACILITY NUMBER: 376618696
	VISIT DATE: 05/12/2022

NARRATIVE

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The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at:
1-844-LET-US-NO (1-844-538-8766) and/or 951-782-4200.

If a civil penalty has been assessed during this inspection, payment is due when billed and the check(s) or money orders shall be made payable to the “California Department of Social Services”. You will receive an invoice in the mail. Do not send money until you receive your invoice. Do not send cash.

See LIC809-D for cited deficiencies.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

An exit interview was conducted, and this report was reviewed with the licensee's daughter and Appeal rights were discussed and provided during the exit interview.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Carlos Martinez	TELEPHONE: (951) 805-5739
LICENSING EVALUATOR NAME: Linda M Almaraz	TELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

LIC809 (FAS) - (06/04)

Page: 21 of 21