376622201-10-10-2022-20-CC-LGAO-CK3UQF-20221010154705

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376622201
Report Date: 10/10/2022
Date Signed: 10/10/2022 07:01:52 PM

Document Has Been Signed on 10/10/2022 07:01 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:	LOPEZ, ANGELICA FAMILY CHILD CARE		FACILITY NUMBER:	376622201
ADMINISTRATOR:	ANGELICA LOPEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 436-8125
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92105
CAPACITY:	14	CENSUS: 7	DATE:	10/10/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Angelica Lopez		TIME COMPLETED:	03:45 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 October 10, 2022 at 10:10AM, Licensing Program Analyst (LPA), Luigi Gargaro conducted an unannounced annual required inspection and met with the facility assistants Rebeca Dominguez and Maria Perez. LPA disclosed the purpose of the inspection and was granted entry into the facility by the day care assistants. Ms. Lopez was out of the home but was contacted by the assistants and arrived at the home shortly after the analyst came. Seven (7) children and Ms. Lopez and her two helpers were present in the facility during this inspection. Ms. Lopez's older school age child who does not count towards the capacity was also present. This facility is a one story, three bedroom, two bathroom home. Licensee accompanied LPA inside and out of the facility during this inspection. The following areas used for child care are: living room/day care area and the day care bathroom. The kitchen has installed safety gates at both entrances to keep children from accessing it during other occasions beside meal times. The children are, however, served meals at the dining area in the kitchen and it was inspected today and verified that it was safely child proofed. Off limits areas are the three home bedrooms with the inclusive master bathroom and are inaccessible through use of door knob covers. Licensee also has an off limits laundry room which is made that way with a door knob cover installed on its door handle and the home garage that has its entrance door behind the off limits laundry room. The fire extinguisher and combination smoke and carbon monoxide detector met requirements. All hazardous items were inaccessible to children. The home has a fenced backyard available for outdoor activities. The two side alleyways, which are used to store personal items and some day care toys and partially as a pet run for licensee's dog, are off limits and made inaccessible with installed safety gates. The yard also contains two off limits storage shed which are made that way with an installed locks. No bodies of water observed on the premises during the inspection. LPA observed locked storage area(s) for firearms and other dangerous weapons. A review of staff records on this date indicates that not all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Helper Maria Perez who was present and working in the facility today does not have fingerprint clearances. Licensee provided proof of Livescan completion form from May of 2021 but form did not show license number for clearance to be associated to facility.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2022

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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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: LOPEZ, ANGELICA FAMILY CHILD CARE	FACILITY NUMBER: 376622201
	VISIT DATE: 10/10/2022

NARRATIVE

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Licensee’s First Aid and CPR certifications have expired. Licensee and helpers did not have proof of required immunizations. Licensee and helper Perez did not have current Mandated Reporter Training certification but Ms. Dominguez did with a certificate completion date of 08/10/21. Facility roster is maintained and was reviewed. The last fire and disaster drills were documented on 04/03/21 and 05/03/21. Licensee stated that both drills were conducted in mid-August of this year but just not doumented. There is one crib or play yard for each infant who is unable to climb out of the crib or play yard. Cribs or play yards are free from all loose articles and objects. The provider physically checks on sleeping infants every 15 minutes. An Individual Infant Sleeping Plan [LIC 9227 (3/20)] is not maintained for each infant up to 12 months of age as licensee currently has no children under 12 months old. The provider understands she is to place infants up to 12 months of age on their backs for sleeping.

LPA provided and discussed the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, and ensure that all adults residing or working in the home have criminal background clearances or exemptions. Licensee was reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers and/or similar equipment are not allowed in daycare. Licensee was also provided handouts with information regarding upcoming Safe Sleep Regulations/SIDS, Lead exposure and Shaken Baby Syndrome. 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.

Incidental Medical services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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.

One type A and four type B violations California Code of Regulations, (Title 22, Division 12 & Chapter 3), are being cited on the attached LIC 809-D.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2022

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: LOPEZ, ANGELICA FAMILY CHILD CARE	FACILITY NUMBER: 376622201
	VISIT DATE: 10/10/2022

NARRATIVE

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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.

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 Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/10/2022 07:02 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: LOPEZ, ANGELICA FAMILY CHILD CARE	FACILITY NUMBER: 376622201
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/10/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Request Denied

Type A

Section Cited

CCR

102370(d)(1)

Criminal Record Clearance

(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above as helper Maria Perez did not have a criminal record clearance which poses an immediate health, safety or personal rights risk to children in care.
	POC Due Date: 10/10/2022
	Plan of Correction
1 2 3 4	Licensee provided signed paperwork from a Postal Annex confirming that assistant did complete the Livescan process but the form did not include the facility license number on it not allowing helper to be assoicated to facility. Helper left during inspection visit to obtain new set of prints and will await clearance results prior to returning to work at the facility.

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: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/10/2022 07:01 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: LOPEZ, ANGELICA FAMILY CHILD CARE	FACILITY NUMBER: 376622201
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/10/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

Licensure Requirements


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

Type B

Section Cited

CCR

102425(j)(2)(B)

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following: Signs of distress which includes but is not limited to flushed skin color, increase in body temperature and restlessness. 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 she has not been keeping safe sleep logs for infants which poses/posed a potential health, safety or personal rights risk to infants in care.
	POC Due Date: 10/17/2022
	Plan of Correction
1 2 3 4	Licensee was unaware of safe sleep log requirements but analyst provided her with a copy of a sample safe sleep log and licensee states she will start mainting log records from today going forward and then submit copies of the logs to analyst by 10/17/22 for records kept for 10/10/22-10/14/22 for all the infants in care to complete the correcion.

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: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/10/2022 07:02 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: LOPEZ, ANGELICA FAMILY CHILD CARE	FACILITY NUMBER: 376622201
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/10/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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 analyst record review], the licensee did not comply with the section cited above as she and helper Maria Perez last completed certificaton on 10/18/18 and 08/23/19, respectively, which poses/posed a potential health, safety or personal rights risk to children in care.
	POC Due Date: 11/14/2022
	Plan of Correction
1 2 3 4	Licensee states that she and helper Perez will take the mandated reporter training class and submit copies of their completion certificates by 11/14/22 to complete the correction.

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on anlayst record review, the licensee did not comply with the section cited above as her CPR/First Aid certifications expired on September of 2022 which poses/posed a potential health, safety or personal rights risk to children in care.
	POC Due Date: 11/14/2022
	Plan of Correction
1 2 3 4	Licensee stated she is signed up for a CPR/First aid class and will submit a copy of her completed certifcations to analyst by 11/14/22 to complete the correction.

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: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2022

LIC809 (FAS) - (06/04)

Page: 5 of 7

Document Has Been Signed on 10/10/2022 07:01 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: LOPEZ, ANGELICA FAMILY CHILD CARE	FACILITY NUMBER: 376622201
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/10/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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 analyst record review, the licensee did not comply with the section cited above as she did not have copies of the immunization records for either herself or her assistants which poses/posed a potential health, safety or personal rights risk to children in care.
	POC Due Date: 11/14/2022
	Plan of Correction
1 2 3 4	Licensee states that she and her helpers will obtain copies of the required immunization records as she believes everyone has had their required shots or obtain any missing immunizations and send proof of them to analyst by 11/14/22 to complete the correction.

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: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2022

LIC809 (FAS) - (06/04)

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