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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376620512
Report Date: 08/05/2021
Date Signed: 09/15/2021 10:13:22 AM

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:FLORES, MARIA IRMA FAMILY CHILD CAREFACILITY NUMBER:
376620512
ADMINISTRATOR:MARIA IRMA FLORESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 563-4511
CITY:SAN DIEGOSTATE: CAZIP CODE:
92104
CAPACITY:14CENSUS: 14DATE:
08/05/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Maria Flores, LicenseeTIME COMPLETED:
12:35 PM
NARRATIVE
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On 08/05/2021, at 11:35 a.m., Licensing Program Analysts (LPAs), Michelle Hood and Cindy Meier conducted an unannounced case management inspection with the Licensee. Fourteen (14) daycare children with two (2) staff present in the facility during this inspection.

During the complaint inspection, it was observed and reviewed by LPAs adult #1, was not fingerprint cleared and associated to the facility. Licensee and adult #1 admitted adult #1 has resided at the facility for six (6) months.

AB633 requires upon receipt, the Licensee shall post (observed by LPAs) and provide copies of this licensing report to parents/guardians of children in care at the facility and parents/guardians of children newly enrolled at the facility during the next 12 months. An Acknowledgment of Receipt of Licensing Reports, Form LIC 9224 must be signed and placed in each child’s file.

A copy of this report, LIC 809D, appeal rights (LIC 9058), LIC 9224, and LIC 9213 – Notice of Site Visit were provided to the licensee. LPAs observed licensee posed the LIC 9213 and the licensee was advised to post the LIC 9213 for 30 days. An exit interview was conducted with the licensee.
SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Michelle HoodTELEPHONE: (691) 767-2241
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021
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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: FLORES, MARIA IRMA FAMILY CHILD CARE
FACILITY NUMBER: 376620512
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/31/2021
Section Cited

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102370(d)(1) Criminal Record Clearance. All individuals subject to a criminal record review as specified in Section 1596.871 prior to working, residing or volunteering in a licensed home, ...a California clearance, or a criminal record exemption as required by the Department. This requirement was not met as evidenced by:
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Based on the licensee and adult #1 admission, the licensee did not ensure that Adult #1 had a criminal record clearance or exemption prior to working, residing, or volunteering in the licensed facility as required, which poses an immediate Health and Safety risk to the children 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: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Michelle HoodTELEPHONE: (691) 767-2241
LICENSING EVALUATOR SIGNATURE:
DATE: 08/05/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/05/2021
LIC809 (FAS) - (06/04)
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