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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376619543
Report Date: 10/09/2019
Date Signed: 10/09/2019 01:19:00 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:NEVAREZ, LOURDES & EDUARDO FAMILY CHILD CAREFACILITY NUMBER:
376619543
ADMINISTRATOR:LOURDES & EDUARDO NEVAREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 562-0509
CITY:SANTEESTATE: CAZIP CODE:
92071
CAPACITY:14CENSUS: DATE:
10/09/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Lourdes & Eduardo NevarezTIME COMPLETED:
01:30 PM
NARRATIVE
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LPA Nancy Diaz conducted an unannounced case management inspection today. Met with licensees Lourdes and Eduardo Nevarez. There was one child observed present today.

This inspection is in reference to an incident that happened in daycare on 8/22/19 wherein a child was bit by another daycare child resulting to an injury that required a doctor's visit. Both licensees failed to report this incident to the department.

Type B deficiency was cited today. Type B deficiency if not corrected poses a potential risk to the health, safety and personal rights of children in care.

LPA observed the Representative post the Notice of Site Visit in a prominent place. The Representative states it is understood that this notice must be posted for 30 days.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2019
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 2
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: NEVAREZ, LOURDES & EDUARDO FAMILY CHILD CARE
FACILITY NUMBER: 376619543
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/09/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/10/2019
Section Cited

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The licensee shall report to the Department any of the events as specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C) that occur during the operation of the family child care home.
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This requirement was not met as evidenced by both licensees' admission that they failed to report to the department an incident that happened on 8/22/19 involving a child biting another child resulting to an injury requiring a doctor's visit.
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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: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:
DATE: 10/09/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/09/2019
LIC809 (FAS) - (06/04)
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