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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376625408
Report Date: 12/05/2022
Date Signed: 12/12/2022 08:02:23 AM


Document Has Been Signed on 12/12/2022 08:02 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: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: 3DATE:
12/05/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Adela RinconTIME COMPLETED:
04:00 PM
NARRATIVE
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On 12/05/2022 at 3:30 pm., Licensing program Analysts (LPA) Adrian Castellon and Julissa Valle conducted an unannounced case management deficiency visit. Upon arrival LPAs met with licensee, Adela Rincon and discussed the purpose of the inspection.

On October 17, 2022 under complaint control number 20-CC-20221019095644, licensee failed to report in a timely manner to the department that child #1 (C1) eloped from the family childcare home unsupervised.

During today’s visit one type B deficiency was issued. The following reports were discussed and provided to the licensee: LIC809 and LIC809-D pages. LPA informed licensee Notice of Site Visit shall be posted for 30 days from today's date. Exit interview conducted with licensee, Adela Rincon.
SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Adrian CastellonTELEPHONE: (619) 767-2237
LICENSING EVALUATOR SIGNATURE:
DATE: 12/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/05/2022
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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Document Has Been Signed on 12/12/2022 08:02 AM - 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: 12/05/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/12/2022
Section Cited

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102416.2 - Reporting Requirements. (b) - The licensee shall report to the Department …(2) - Any child absence…any child in care who wanders away from the Family Child Care Home…shall be reported even if the child is later found safe.
This requirement was not met as evidenced by:
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Licensee reported the incident via the LIC624B Unusual Incident Report on September 08, 2022. Licensee indicated she will watch the following video titled; Childcare Reporting Requirements under https://ccld.childcarevideos.org for family childcare providers and provide an outline of the video.
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Based on licensee’s admission and record review, licensee did not comply with the section cited above as licensee didn’t report the incident to the department regarding C1 eloping from the facility unsupervised, which poses a potential health, safety risk to the children in care.
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Plan of correction shall be submitted to the department by:10/14/22.

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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: Adrian CastellonTELEPHONE: (619) 767-2237
LICENSING EVALUATOR SIGNATURE:
DATE: 12/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/05/2022
LIC809 (FAS) - (06/04)
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