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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376620238
Report Date: 05/05/2022
Date Signed: 05/05/2022 11:51:25 AM


Document Has Been Signed on 05/05/2022 11:51 AM - 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:MARTINEZ, GRACIELA FAMILY CHILD CAREFACILITY NUMBER:
376620238
ADMINISTRATOR:GRACIELA MARTINEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 421-3576
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY:14CENSUS: 6DATE:
05/05/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Graciela Martinez, ProviderTIME COMPLETED:
11:55 AM
NARRATIVE
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Licensing Program Analyst (LPA) D. Sanchez, conducted a Case Management during a Complaint inspection. During the complaint investigation it was determined that provider failed to verbally report, within 24 hours, the incident occurred on 2/10/2022, where three children three (3) daycare children left the facility unattended. Licensee also failed to submit a written Unusual Incident/Injury Report (LIC-624B) within 7 days. Licensee stated that she didn’t know she had to report the incident to the San Diego Child Care Regional Office (SDCCRO).

During the records review, LPA noticed that the required AB-1207 Mandated Reporter training was taken on 02/02/2018 and is now expired. Provider stated she was not aware that the certificate needed to be reviewed every two years.
The Mandated Reporter training link: www.mandatedreporterca.com

California Code of Regulations, (Title 22, Division 12 & Chapter 3), are being cited on the attached LIC 809-D.

An exit interview was conducted with the licensee. The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.

LPA provided notice of site visit and observed it being posted at the facility.
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Diana SanchezTELEPHONE: (619) 767- 2210
LICENSING EVALUATOR SIGNATURE:
DATE: 05/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/05/2022
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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Document Has Been Signed on 05/05/2022 11:51 AM - 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: MARTINEZ, GRACIELA FAMILY CHILD CARE
FACILITY NUMBER: 376620238

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/05/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/09/2022
Section Cited

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Reporting Requirements. The licensee shall report to the Department any of the events as specified in Health and Safety Code Section 1597.467(b)(1)(A)
through (b)(1)(C) that occur during the operation of the family child care home.
This requirement was not met as evidenced by:
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Based on licensee’s admission and records reviewed, licensee failed to submit a written unusual incident report about a significant lack of supervision incident that occurred on 02/10/2022, when three children walked out of the day care facility unsupervised, which poses an immediate Health and Safety risk to children in care.
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Type B
05/09/2022
Section Cited

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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... 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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This requirement was not met as evidenced by: Based on record review, the licensee did not comply with the section cited above. Provider failed to renew AB-1207 Mandated Reported certificate dated 02/02/2018, which posed a potential health, safety or personal rights risk to persons 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: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Diana SanchezTELEPHONE: (619) 767- 2210
LICENSING EVALUATOR SIGNATURE:
DATE: 05/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/05/2022
LIC809 (FAS) - (06/04)
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