376622130-4-21-2023-20-CC-CMER-CR4UG3-20230421153340

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376622130
Report Date: 04/21/2023
Date Signed: 04/21/2023 03:33:58 PM

Document Has Been Signed on 04/21/2023 03:33 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:	MALDONADO, MIRIAM FAMILY CHILD CARE		FACILITY NUMBER:	376622130
ADMINISTRATOR:	MIRIAM MALDONADO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 587-8235
CITY:	SAN YSIDRO	STATE: CA	ZIP CODE:	92173
CAPACITY:	14	CENSUS: 2	DATE:	04/21/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Miriam Maldonado		TIME COMPLETED:	12:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 4/21/2023, at 9:15 a.m., Licensing Program Analyst (LPA), Cindy Meier conducted an unannounced Annual Inspection and met with Licensee, Miriam Maldonado. LPA disclosed the purpose of the inspection and was led on a tour of the facility indoors and outdoors. This facility is a two story, four-bedroom, two-and-a-half-bathroom house. The following areas are used for childcare: living room (playroom #1), dining room (playroom #2) and downstairs half bathroom. Off limits areas include: Downstairs: kitchen, outdoor storage shed and garage. Off limit areas include: Upstairs: bedrooms #1, #2, #3, #4 and bathrooms #1 and #2 which are made inaccessible through the use baby gates, locks and doorknob covers. The fireplace located in the living room is screened and inaccessible to children. LPA informed licensee when children less than five years old are in care, stairs shall be fenced or barricaded. Stairs are inaccessible to children through a baby gate. Hours of operation hours are Monday – Sunday, 23 hours. There were three (3) children present during the inspection, one (1) infant and two (2) preschoolers, and two (2) assistants S(1) and S(2). The fire extinguisher, smoke detector and carbon monoxide detector met requirements. Hazardous items were inaccessible to children in care. LPA informed licensee poisons shall be placed in a storage area and locked. LPA did not observe any poisons during the inspection. The storage area for poisons is locked. LPA observed toys and materials available for children’s use. The home has a fenced backyard available for outdoor activities. LPA informed licensee to ensure children are supervised at all times during outdoor activities. Licensee stated there are no bodies of water and LPA did not observe any bodies of water during the inspection. Licensee stated there are no firearms, other weapons or ammunition in the home.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Cindy Meier	TELEPHONE: (619) 767-2232
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023

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 04/21/2023 03:33 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: MALDONADO, MIRIAM FAMILY CHILD CARE	FACILITY NUMBER: 376622130
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(1)

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on analyst interview and record review, the licensee did not comply with the section cited above as licensee is not documenting the infant in care's sleeping status every 15 minutes as required by regulation which poses/posed a potential health, safety or personal rights risk to the child in care.
	POC Due Date: 04/28/2023
	Plan of Correction
1 2 3 4	Licensee was provided with a sample Safe Sleep log and stated she will begin documenting infants sleeping status every 15 minutes. The Licensee will send a copy of the completed log for the dates of 4/24/23 - 4/28/23 to analyst by 4/28/23.

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) 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 provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the Licensee and S(1) and S(2) did not comply with the section cited above in that their Mandated Reporter Training expired in 2018 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/19/2023
	Plan of Correction
1 2 3 4	LPA provided Licensee with written instructions on how to locate the Mandated Reporter Training online. Licensee states all will complete this online course and provide LPA with a copy of the training completion certificate no later than 05/19/2022.

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 Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Cindy Meier	TELEPHONE: (619) 767-2232
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/21/2023 03:33 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: MALDONADO, MIRIAM FAMILY CHILD CARE	FACILITY NUMBER: 376622130
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416.1(a)

Personnel Records

(a) Personnel records shall be maintained on each employee and shall contain the following information: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in that S(1) did not have required personnel records completed and on file which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/28/2023
	Plan of Correction
1 2 3 4	LPA discussed form LIC311D which lists required forms for employees. Licensee will have S(1) complete forms and licensee will send a copy of completed forms to CCLD by 4/28/23.

Type B

Section Cited

HSC

1597.622(a)(1)

General Provisions and Definitions

(1) 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. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and file review at annual inspection, licensee and assistants S(1) and S(2) did not have the required immunization's, (TB, MMR, dTap and Influenza) on file for review which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/05/2023
	Plan of Correction
1 2 3 4	Licensee stated she will obtain copies of required immunization's for licensee and S(1) and S(2) and submit to CCLD by 5/5/23.

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 Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Cindy Meier	TELEPHONE: (619) 767-2232
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/21/2023 03:33 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: MALDONADO, MIRIAM FAMILY CHILD CARE	FACILITY NUMBER: 376622130
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(7)

Operation of A Family Child Care Home

(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in (3) out of (3) children in care did not have all of required forms completed in file which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/05/2023
	Plan of Correction
1 2 3 4	LPA provided Licensee the LIC311D which lists required forms for children's files. Licensee stated she will provide the three children's completed files to LPA by 5/5/23.

Type B

Section Cited

CCR

102417(g)(8)

Operation of A Family Child Care Home

(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on analyst record review, the licensee did not comply with the section cited above as it was determined that the facility roster is not being maintained and is outdated which poses/posed a potential health, safety or personal rights risk to children in care.
	POC Due Date: 04/28/2023
	Plan of Correction
1 2 3 4	LPA provided licensee with a blank facility roster during today's visit. Licensee states that she will fill out the roster listing all the children in care and their corresponding required personal information and then submit a copy of the completed roster to CCLD by 04/28/23.

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 Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Cindy Meier	TELEPHONE: (619) 767-2232
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/21/2023 03:33 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: MALDONADO, MIRIAM FAMILY CHILD CARE	FACILITY NUMBER: 376622130
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(c)

Infant Safe Sleep

An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and Licensee's statement that there is no LIC 9227 form for the infant, the licensee did not comply with the section cited above in that one (1) out of one (1) infants lacks a completed LIC 9227 Individual Sleeping Plan on file, which poses as a potential health, safety or personal rights risk to children in care.
	POC Due Date: 04/28/2023
	Plan of Correction
1 2 3 4	LPA provided Licensee with a blank LIC 9227 form and PIN 20-24-CCP "Safe Sleep Regulations". The Licensee stated she will submit a copy of the completed LIC 9227 for the infants in care for the plan of correction to the CCLD by 4/28/23..

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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 Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Cindy Meier	TELEPHONE: (619) 767-2232
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023

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: MALDONADO, MIRIAM FAMILY CHILD CARE	FACILITY NUMBER: 376622130
	VISIT DATE: 04/21/2023

NARRATIVE

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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.
A review of staff records on this date indicates that licensee’s assistant S(1) does not have a personnel record on file.

Three (3) children’s files were reviewed, and all three (3) files were incomplete and missing required documents.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Mandated Reporter AB1207 training for Licensee and assistants expired in 2018. Pediatric CPR and First Aid certifications expire in 2024. Property Owner/Landlord Consent form LIC9149 is on file, signed by landlord and approves licensee to care for fourteen (14) children. Licensee’s required immunizations were not available for review. Facility roster was reviewed but not current. The licensee has conducted fire drills but are not documented. Required documents are posted. There is one crib or play yard for each infant who is unable to climb out of the crib or play yard.

Incidental Medical Services (IMS) policy were discussed. 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.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Cindy Meier	TELEPHONE: (619) 767-2232
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023

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: MALDONADO, MIRIAM FAMILY CHILD CARE	FACILITY NUMBER: 376622130
	VISIT DATE: 04/21/2023

NARRATIVE

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LPA discussed safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPA and licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov. LPA discussed and provided Licensee with the following: child care advocates email address: childcareadvocatesprogram@dss.ca.gov. In addition, for general questions or questions regarding licensing requirements contact the Child Care Licensing Duty Line at (619) 767-2248.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication. LPA reviewed with licensee the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/tion-process.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Cindy Meier	TELEPHONE: (619) 767-2232
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023

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: MALDONADO, MIRIAM FAMILY CHILD CARE	FACILITY NUMBER: 376622130
	VISIT DATE: 04/21/2023

NARRATIVE

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Per California Code of Regulations, (Title 22, division 12 & Chapter 3) seven (7) Type B citations and one (1) Technical Violation are being cited on the attached LIC 809-D.

Exit interview conducted and report was reviewed with licensee, Miriam Maldonado. A copy of this report, along with Appeal Rights (LIC9058), were provided. A notice of site visit was given and must remain posted for 30 days. LPA observed that the notice of site visit was posted during the inspection. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Cindy Meier	TELEPHONE: (619) 767-2232
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023

LIC809 (FAS) - (06/04)

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