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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376625408
Report Date: 06/08/2023
Date Signed: 06/08/2023 01:33:24 PM


Document Has Been Signed on 06/08/2023 01:33 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:RINCON, ADELAIDA FAMILY CHILD CAREFACILITY NUMBER:
376625408
ADMINISTRATOR:ADELAIDA RINCONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 475-6506
CITY:SAN DIEGOSTATE: CAZIP CODE:
92139
CAPACITY:14CENSUS: 7DATE:
06/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:TIME COMPLETED:
01:40 PM
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On 06/08/2023 at 11:00 AM, Licensing Program Analyst (LPA), Dana Stevens conducted an unannounced Annual Required Inspection and met with licensee Adelaida Rincon. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. Licensee's daughter/assistant was also present with eight daycare at the time of the inspection. Licensee's daughter/assistant provided translation assistance in Spanish. Licensee accompanied LPA throughout the inspection of this 3 bedroom, 1 bathroom home. The following areas are used for child care: living room, kitchen, dining area two bedrooms and bathroom. Off-limits areas are 1 bedrooms and backyard. Front yard is also currently off-limits due to construction. These areas are made inaccessible with door knob covers and door locks. The neighborhood park is used for outdoor activities, licensee stated total supervision is provided.

The fire extinguisher, smoke detector, and carbon monoxide detector met requirements.  The licensee has toys, play equipment and materials available. Licensee stated there are no weapons in the home. A review of records on this date indicates that all individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Licensee's and assistants CPR/First Aid certification expires 07/2024.  Facility roster and children's files were reviewed. Sleep logs for infants under 2 years of age were not current and Infant sleep plan was not available for the one infant under 12 months of age. Licensee's and Assistant's Mandated Reporter training was renewed 11/2022. Last Fire Drill was completed 11/2022.



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.
SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Dana StevensTELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:
DATE: 06/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/08/2023
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: RINCON, ADELAIDA FAMILY CHILD CARE
FACILITY NUMBER: 376625408
VISIT DATE: 06/08/2023
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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 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.

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.

California Code of Regulations, (Title 22, Division 12 & Chapter 3), are being cited on the attached LIC 809-D.



Exit interview conducted and copy of report and appeal rights were provided to the licensee and their signature on this form acknowledges receipt of these rights.

A notice of site visit was given and must remain posted for 30 days

SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Dana StevensTELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 06/08/2023 01:33 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: RINCON, ADELAIDA FAMILY CHILD CARE
FACILITY NUMBER: 376625408

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/08/2023

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
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Based on record review, the licensee did not comply with the section cited above by not having an Individual Infant Sleep Plan LIC9227 for the one infant under 12 months of age, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/10/2023
Plan of Correction
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Licensee will ensure a completed Individual Infant Sleep Plan LIC 9227 is included in the file of all infants under 12 months and provide prood of completion to LPA within 30 days.
Type B
Section Cited
CCR
102425(j)(2)(D)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above by not having current sleep logs for all children under 2 years of age, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/10/2023
Plan of Correction
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Licensee will maintain current sleep logs for all children under two years of age, and provide proof of completion to LPA within 30 days.
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 GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Dana StevensTELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:
DATE: 06/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/08/2023
LIC809 (FAS) - (06/04)
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