376625406-7-29-2021-20-CC-MHEZ-C5DTG6-20210729144237

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376625406
Report Date: 07/29/2021
Date Signed: 07/29/2021 02:42:45 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:	GIL-CERVANTES, SANDRA FAMILY CHILD CARE		FACILITY NUMBER:	376625406
ADMINISTRATOR:	SANDRA GIL-CERVANTES		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 807-6950
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92113
CAPACITY:	14	CENSUS: 7	DATE:	07/29/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Sandra Gil-Cervantes, Licensee		TIME COMPLETED:	02:42 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 July 29, 2021, at 12:40 PM, Licensing Program Analysts (LPA's), Marie Hernandez and Cindy Meier conducted an unannounced Annual Required Inspection and met with the Adult Helper, Elizabeth Gil-Cervantes and with the Licensee via phone. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Adult Helper, Elizabeth Gil-Cervantes. Via phone, the Licensee stated she is at the local park with six children, and that her adult helper Elizabeth Gil-Cervantes can assist LPA's with the inspection. During the inspection, a day care child arrived at the facility. This facility is a one story, four bedroom, and two bathroom home. The Adult Helper accompanied LPA's on the tour inside and outside of the facility during this inspection. The following areas are used for child care are: The dining room, living room, kitchen, bedroom #1 and bedroom #2, hallway bathrooms and the backyard. The off limit areas are bedrooms #3 & 4 . The off limits areas are inaccessible through use of a child proof door knobs. The fire extinguisher, smoke detector, and carbon monoxide detector met requirements. All hazardous items were inaccessible to children. The storage area for poisons is locked. The licensee has toys, play equipment and materials available. No bodies of water observed on the premises during the inspection. The Licensee stated there are no weapons in the home. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received a criminal record and child abuse clearances or exemptions. Licensee’s First Aid and CPR certifications expired on 07/2023. The Licensee and the adult helper have the required immunization records. The Licensee's Mandated Reporter certification expires on 11/25/2022. The mandated reporter certification must be renewed every two years prior to expiration. The Licensee conducted the fire/disaster drill on 06/20/2021. LPA discussed and provided the Safe Sleep handouts including the Individual Infant Sleeping Plan [LIC 9227 (3/20)]. The Licensee stated it is understood. The Licensee has not maintained the documentation of infant fifteen minute checks. LPA 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 day-care. 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.

SUPERVISOR'S NAME: Cynthia Gray	TELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Marie Hernandez	TELEPHONE: (619) 767-2244
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021

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: GIL-CERVANTES, SANDRA FAMILY CHILD CARE	FACILITY NUMBER: 376625406
	VISIT DATE: 07/29/2021

NARRATIVE

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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.

The following deficiency was cited on page 2 809-D. An exit interview was conducted with the Adult Helper, Elizabeth Gil-Cervantes and with the Licensee via phone. The Adult Helper was provided a copy of the report, notice of site visit and the appeal rights. LPA provided notice of site visit, and observed it being posted at the facility.

SUPERVISOR'S NAME: Cynthia Gray	TELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Marie Hernandez	TELEPHONE: (619) 767-2244
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021

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: GIL-CERVANTES, SANDRA FAMILY CHILD CARE	FACILITY NUMBER: 376625406
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/29/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/30/2021 Section Cited	1 2 3 4 5 6 7	102425(j)(i) Infant Safe Sleep -The provider shall supervise infants while they are sleeping...The provider shall physically check on the infant every 15 minutes and document the fifteen minute checks. This requirement was not met as evidenced by records review by LPA.
	8 9 10 11 12 13 14	The Licensee has an infant age one and half years old but there is no documentation of the infant safe sleep fifteen minute checks for infants 0 through 24 months. This poses a potential safety risk to children in care.	8 9 10 11 12 13 14	The appeal rights were discussed and provided to the Licensee via phone and a copy was provided to the Adult Helper, Elizabeth Gil-Cervantes.
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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 Gray	TELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Marie Hernandez	TELEPHONE: (619) 767-2244
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021

LIC809 (FAS) - (06/04)

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