376624379-6-20-2023-20-CC-GGOZ-CSYPBG-20230620111020

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376624379
Report Date: 06/20/2023
Date Signed: 06/20/2023 11:10:26 AM

Document Has Been Signed on 06/20/2023 11:10 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:	ROQUE SEGARRA, MITZY FAMILY CHILD CARE		FACILITY NUMBER:	376624379
ADMINISTRATOR:	MITZY ROQUE SEGARRA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 690-9395
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92154
CAPACITY:	14	CENSUS: 7	DATE:	06/20/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Mitzy Roque Segarra		TIME COMPLETED:	11:30 AM

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 June 20, 2023, at 8:30 a.m., Licensing Program Analyst (LPA), Gloria Gonzalez conducted an unannounced Annual Required Inspection and met with the Licensee, Mitzy Roque Segarra. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. Seven (7) daycare children and two (2) staff members, and Licensee's spouse as a helper, were present in the facility during this inspection. This facility is a 2 story, 4 bedroom, 3 bathroom house. Licensee accompanied LPA inside and out of the facility during this inspection. The following areas used for child care are: living room, family room, kitchen, dining room/office, kids area (covered patio pending review of when it was cleared and inspected), and downstairs hallway bathroom. Off limits areas are garage, all of upstairs (bedrooms #1-#4, bathrooms #2-#3), and are inaccessible through use of door lock and a safety gate. Hours of operation are: Monday-Friday from 4:30 am-4:30 pm. The fire extinguisher, smoke detector, and carbon monoxide detector met requirements. Hazardous items were made inaccessible to children during the inspection. The licensee has toys, play equipment and materials available. The home has a fenced backyard available for outdoor activities at time of inspection. The upstairs is not used and is gated off at the bottom of the stairway and the Licensee understands the gate must be in place when children under five years are present during day care hours. 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 all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances. 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.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Gloria Gonzalez	TELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

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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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: ROQUE SEGARRA, MITZY FAMILY CHILD CARE	FACILITY NUMBER: 376624379
	VISIT DATE: 06/20/2023

NARRATIVE

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Licensee’s First Aid and CPR certification expires on 10/2023. Licensee has required immunizations. Licensee completed Mandated Reporter Training on 9/8/22. Facility roster is maintained and was reviewed. The last fire and disaster drills were conducted and documented on 4/14/23.

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. Licensee physically checks on sleeping infants up to 24 months of age every 15 minutes. An Individual Infant Sleeping Plan [LIC 9227 (3/20)] is maintained for each infant up to 12 months of age. Licensee places infants up to 12 months of age on their backs for sleeping. LPA discussed the 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 provided and discussed the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms. 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 information regarding SIDS, Lead exposure and Shaken Baby Syndrome. LPA and Licensee discussed California Megan's Law and LPA provided:www.meganslaw.ca.gov.
LPA advised if there is an unusual incident to report to call Licensing within 24 hours and to follow up with an LIC624B within 7 days. In addition, for general questions, questions regarding licensing requirements call Child Care Licensing.

Duty Line at (619) 767-2248. Access our updated Regulation & Forms by using our WEBSITE: http://ccld.ca.gov.

LPA discussed and provided Licensee with the following: child care advocates email address: childcareadvocatesprogram@dss.ca.gov.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Gloria Gonzalez	TELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

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: ROQUE SEGARRA, MITZY FAMILY CHILD CARE	FACILITY NUMBER: 376624379
	VISIT DATE: 06/20/2023

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.

LPA advised the Licensee that prior to making alterations or additions to the home or grounds, the Licensee shall notify the Department of the proposed change.

No deficiencies cited.

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/‌inspection-process.

A copy of the report and appeal rights (LIC 9058) and notice of site visit (LIC9213) was provided to Licensee and must remain posted for 30 days.

An exit interview was conducted and report was reviewed with the licensee, Mitzy Roque Segarra

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Gloria Gonzalez	TELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

LIC809 (FAS) - (06/04)

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