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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376619276
Report Date: 07/17/2019
Date Signed: 07/17/2019 05:15:01 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:GODINEZ, ANNA FAMILY CHILD CAREFACILITY NUMBER:
376619276
ADMINISTRATOR:ANNA GODINEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 756-4460
CITY:SAN DIEGOSTATE: CAZIP CODE:
92102
CAPACITY:14CENSUS: 6DATE:
07/17/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Anna GodinezTIME COMPLETED:
05:25 PM
NARRATIVE
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(3) Licensing Program Analysts (LPAs) Selina Siao and Michelle Palacio conducted an unannounced random inspection with the Licensee. The home was toured and inspected to ensure an environment safe for the care and supervision of children. Present at the facility were the Licensee, her husband Jesus Godinez, 5 children including two infants and a school age child. Licensee's school age son is also at the home. Licensee's adult daughter Eliana Godinez arrived at the facility during the inspection. The home has a fully charged fire extinguisher, smoke and carbon monoxide detector that meet requirements and are operational. Not all hazardous items were latched/locked and secured out of reach of children. There are no bodies of water observed at the home. Licensee stated that the home does not have any 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 cards are current due to expire on 03/2020 and Licensee's husband/helper Jesus Godinez's First Aid and CPR are current due to expire on 09/2029. Children’s records were reviewed. Facility has an updated roster and fire drill log available for review. Licensee last conducted a drill with the children in care on 06/14/2019.

Licensee has provided adequate space for the children to eat, sleep and play within the home. Areas used for child care include family room (main day care area), bathroom and licensee requested to add her living room for day care children to use as well. Off limits areas are the two bedrooms. Facility has ample toys and equipment for children. The home has a fenced backyard available for outdoor activities.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina SiaoTELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2019
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 4
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: GODINEZ, ANNA FAMILY CHILD CARE
FACILITY NUMBER: 376619276
VISIT DATE: 07/17/2019
NARRATIVE
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The following items were discussed with provider: Licensee was reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers are not allowed in day care. Licensee was provided with information about Heat Related Illness, Sudden Infant Death Syndrome (SIDS), Never Shake a Baby, Safe Sleep Concept, best practice on supervision, latest car seat poster and effects of lead exposure and reporting responsibilities were discussed.

Per new Senate Bill 792 pertaining to immunizations, which require all adults in daycare operation to have proof of immunizations for; Measles, Pertussis and influenza. Licensee and her husband's immunization records are not available for review.

Licensee was advised to email childcareadvocatesprogram@dss.ca.gov to request to be on the distribution list to obtain child care updates. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov. Community Care Licensing website is www.ccld.ca.gov.

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

See LIC809D for deficiencies:



A Notice of Site Visit was posted today, and it must remain posted for a period or 30 days. Failure to keep notice posted will result in a civil penalty of $100.00. Provided appeal rights to licensee today.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Selina SiaoTELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: GODINEZ, ANNA FAMILY CHILD CARE
FACILITY NUMBER: 376619276
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/17/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/06/2019
Section Cited
HSC
1597.622(a)(1)
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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.
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Licensee stated that she will locate her and her husband's required immunization records. Licensee will submit the information to Analyst by 08/06/2019.
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This requirement was not met as evidence by: Licensee and her husband's required immunizations are not available for review during the inspection. This poses a potential health and safety risk to clients in care.

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Type B
08/06/2019
Section Cited
HSC
1596.8662(4)(b)(2)
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On and after January 1, 2018, a person who applies for a license to be a provider of a child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a) as a precondition to licensure and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
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Licensee stated that her and her husband will take the online mandated child abuse training. A copy of the certificate will be submitted to Analyst by 08/06/2019.
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This requirement was not met as evidence by: Licensee and her husband's mandated child abuse training certificate are not available for review. This poses a potential health and safety risk to clients 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: Selina SiaoTELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: GODINEZ, ANNA FAMILY CHILD CARE
FACILITY NUMBER: 376619276
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/17/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/18/2019
Section Cited
CCR
102417(g)(4)
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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.
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Licensee stated that she will purchase three safety latches for her new bathroom cabinets. A picture of the installed latches will be submit to Analyst by 07/18/2019.
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This requirement is not met as evidence by: There were multiple bottles of mouthwash, personal items, air fresheners in the cabinet under the sink, medicine cabinet, cabinet above the toilet that are accessible to children. This poses a potential health and safety risk to clients 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: Selina SiaoTELEPHONE: (619) 767-2217
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4