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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376619795
Report Date: 05/24/2022
Date Signed: 05/24/2022 02:34:13 PM


Document Has Been Signed on 05/24/2022 02:34 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:DELA CRUZ, EDEN FAMILY CHILD CAREFACILITY NUMBER:
376619795
ADMINISTRATOR:EDEN DELA CRUZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 566-9342
CITY:SAN DIEGOSTATE: CAZIP CODE:
92126
CAPACITY:14CENSUS: 9DATE:
05/24/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:51 PM
MET WITH:Eden Dela CruzTIME COMPLETED:
02:45 PM
NARRATIVE
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On 5/24/2022 @ 1:15PM, LPA Nancy Diaz conducted an unannounced case management inspection. Observed present today were 9 children (4 of those children were under the age of two). Licensee Mrs. Dela Cruz and her husband were observed providing care and supervision to children. Upon arrival, LPA observed four children in the nap room, two were seated in a rocker and 2 were seated in a swing. Mrs. Dela Cruz was again reminded that the baby rocker is a prohibited item.

It is being noted that Mrs. Dela Cruz was cited in 9/1/2016 when 4 infant rockers were observed present in the home.

A review of children's records today indicated that Mrs. Dela Cruz did not maintain Individual Infant Sleeping Plan (form LIC 9227) or infant sleep log.

Type A and B deficiencies were cited today.

Type A violation if not corrected, will have a direct and immediate risk to the health, safety, or personal rights of children in care.

Type B violation if not corrected, is a potential risk to the health, safety, or personal rights of children in care.

Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

Exit interview was conducted today with Mrs. Dela Cruz. A copy of this report and appeal rights were provided. Notice of site visit was observed posted.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2022
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 3


Document Has Been Signed on 05/24/2022 02:34 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: DELA CRUZ, EDEN FAMILY CHILD CARE
FACILITY NUMBER: 376619795

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/24/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/24/2022
Section Cited

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OPERATION OF A FAMILY CHILD CARE HOME.
The home shall provide safe toys, play equipment and materials.

This requirement was not met as evidenced by:
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Based on LPA's observation at 12:45PM, 2 children were seated in a rocker and 2 children in a swing. Having children seated in the rocker or swing restrains them from moving freely.
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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: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3


Document Has Been Signed on 05/24/2022 02:34 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: DELA CRUZ, EDEN FAMILY CHILD CARE
FACILITY NUMBER: 376619795

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/24/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/31/2022
Section Cited

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INFANT SAFE SLEEP
An individual sleeping plan (LIC 9227) shall be completed for each infant up to 12 months.
This requirement was not met as evidenced by
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Based on LPA's review of children's files, Mrs. Dela Cruz did not maintain individual sleeping plan for each infant under 12 months old.
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Type B
05/31/2022
Section Cited

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INFANT SAFE SLEEP
Documentation shall be maintained in the infant's file an be available to the department for review.
This requirement was not met as evidenced by
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Based on LPA's review of children's files, Mrs. Dela Cruz did not maintain infant sleep log.
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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: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3