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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376622824
Report Date: 07/22/2019
Date Signed: 07/22/2019 12:09:54 PM

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:MEDEROS, FIDELIA FAMILY CHILD CAREFACILITY NUMBER:
376622824
ADMINISTRATOR:FIDELIA MEDEROSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 204-8841
CITY:SAN DIEGOSTATE: CAZIP CODE:
92104
CAPACITY:14CENSUS: 9DATE:
07/22/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Fidelia & Ruby MederosTIME COMPLETED:
12:15 PM
NARRATIVE
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An unannounced random inspection was conducted today by LPAs Nancy Diaz and Michael Morales-DeSilvestore. Upon arrival LPA observed 9 children in care with the licensee, Fidelia Mederos and daughter Ruby Mederos. Children were participating in various indoor activities. LPA conducted a tour of the home to ensure the health and safety of children. Licensee is using the following areas for daycare: living room, dining and hallway bathroom. The following areas are off-limits to children: all three bedrooms, kitchen area and laundry area. These areas are inaccessible to children via locked doors and barricade.

Ruby stated that Mrs. Mederos does not maintain any weapons or bodies of water within the premises. All cleaners, toxics, medications and other hazardous substances are inaccessible to children in care via latched cabinet or storage in upper cabinet. Fire extinguisher and smoke detectors present in the home meet State Fire Marshall standards. A carbon monoxide is also maintained in the home. The home is kept clean and orderly with sufficient ventilation for safety and comfort. The home provides toys, play equipment and materials. The home maintains a working telephone service.

Outdoor play is provided at a nearby park, located one block from daycare. The licensee maintains current emergency information on all the children. The licensee has a current Pediatric CPR and First Aid certificate and is valid thru May 2021.

A handout was provided to the licensee today on “Effects of Lead Exposure”. Licensee shall provide a copy of this handout to all the daycare parents.


Facility has not exceeded the capacity specified on the license. Licensee resides in this home with husband Saul Mederos and daughter Ruby Mederos. There are no new adults living or working in the home over the age of 18 years. All individuals subject to criminal record review have obtained criminal record clearance or exemption prior to working, residing or volunteering.

CONTINUED ON PAGES 2 & 3.
SUPERVISOR'S NAME: Carolina RamosTELEPHONE: (619) 767-2206
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2019
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
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: MEDEROS, FIDELIA FAMILY CHILD CARE
FACILITY NUMBER: 376622824
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/31/2019
Section Cited
HSC
1597.822
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FCC – H & S Section 1597.622. Effective September 1, 2016, a person may not be employed or volunteer at a family child care home unless he or she has been immunized against influenza, pertussis, and measles.
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Mrs. Mederos stated that she will obtain her immunization record to show that she was immunized against Pertussis, Measles & Influenza and submit a copy to the department no later than July 31, 2019.
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This regulation was not met as evidenced by LPA's review of facility record. Licensee, Fidelia Mederos did not have proof of being immunized against Pertussis, Measles and Influenza.
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Type B
07/31/2019
Section Cited
HSC
1596.8662
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H & S Section 1596.8662 create requirements for mandated child abuse reporter training. Applicants, licensees, and facility employee may meet this requirement free of cost by accessing the online training module provided on the Department of Social Services, Mandated Reporter Training Website: www.mandatedreporterca.com (effective 1/1/2018)
This requirement was not met as evidenced by LPA's review of facility records. Ruby Mederos has not completed the required Mandated Reporter course.

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CORRECTED DURING THE VISIT. MS. MEDEROS FOUND BOTH TRAINING CERTIFICATES COMPLETED IN APRIL 2019.
Type B
07/31/2019
Section Cited
CCR
102417(g)(8)
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Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.
This regulation requirement was not met as evidenced by LPAs review of facility records. Mrs. Mederos did not maintain a current children's roster.
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LPA has provided a copy of form LIC 9040 (Children's Roster). Ruby Mederos stated that she will update the roster and submit a copy to the department no later than July 31, 2019.
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: Carolina RamosTELEPHONE: (619) 767-2206
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3
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: MEDEROS, FIDELIA FAMILY CHILD CARE
FACILITY NUMBER: 376622824
VISIT DATE: 07/22/2019
NARRATIVE
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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

Licensee, Fidelia Mederos is exempt from Mandated Reporter AB1207 training certification due to having limited English proficiency. Mrs. Mederos' primary language is Spanish.



LPA observed the Representative post the Notice of Site Visit in a prominent place. The Representative states it is understood that this notice must be posted for 30 days.



TYPE B DEFICIENCIES WERE CITED TODAY. Type B violation if not corrected, could become a risk to the health, safety, or personal rights of children in care.
SUPERVISOR'S NAME: Carolina RamosTELEPHONE: (619) 767-2206
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3