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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376625807
Report Date: 03/16/2022
Date Signed: 03/16/2022 02:24:59 PM


Document Has Been Signed on 03/16/2022 02:24 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:VILLALPANDO, ALEXIS & ELIZABETH FAMILY CHILD CAREFACILITY NUMBER:
376625807
ADMINISTRATOR:ALEXIS VILLALPANDOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 274-3355
CITY:SAN DIEGOSTATE: CAZIP CODE:
92119
CAPACITY:14CENSUS: 9DATE:
03/16/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:49 AM
MET WITH:Alexis VillalpandoTIME COMPLETED:
02:30 PM
NARRATIVE
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On 3/16/22, Licensing Program Analysts (LPA), Tyra Block, conducted a Proof of Correction visit to verify corrections were made from Annual inspection on 2/24/22. LPA met with Licensee, Alexis Villalpando. Present at the child care home was 9 children, co-licensee Elizabeth and licensee's father. Staff #2 arrived later during the visit.

LPA observed updated form LIC 610 (Emergency Disaster Plan) posted and reviewed the drill log, children's Facility Roster, and children and staff records. Staff records were incomplete. Preventative Health and Safety and Mandated Reporter training was not renewed for both licensees. Additionally, some staff were missing required forms and immunizations.

See LIC 809-D for deficiencies cited during today's visit.

A Notice of Site Visit was provided and must be posted for 30 days.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Tyra BlockTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:
DATE: 03/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/16/2022
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


Document Has Been Signed on 03/16/2022 02:25 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: VILLALPANDO, ALEXIS & ELIZABETH FAMILY CHILD CARE
FACILITY NUMBER: 376625807

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/16/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/01/2022
Section Cited

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102416.1(a) Personnel Records- Personnel records shall be maintained on each employee and shall contain the following information... This requirement was not met as evidenced by:
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Based on record review and interview with licensee, Alexis Villalpando staff records were incomplete, missing several forms including LIC 508, LIC 9052, and LIC 9108. This poses an potential health and safety risk to children in care.
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Type B
04/01/2022
Section Cited

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102416(c) Personnel Records- The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement was not met as evidenced by:
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Based on interview and record review, licensee Alexis, provided a copy of receipt for enrollment in CPR/ FA for herself and co-licensee. This poses a potential health and safety risk to childrne in care.
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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: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Tyra BlockTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:
DATE: 03/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/16/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3


Document Has Been Signed on 03/16/2022 02:25 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: VILLALPANDO, ALEXIS & ELIZABETH FAMILY CHILD CARE
FACILITY NUMBER: 376625807

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/16/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/01/2022
Section Cited

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1596.8662(b)(1)... training for mandated reporter who is licensed day care provider, administrator, or employee of a licensed child day care facility; proof of completion ... a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training... and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement was not met as evidenced by:
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Based on record review and interview, staff did not complete Mandated Reporter training. This poses a potential health and safety risk to children in care.
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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: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Tyra BlockTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:
DATE: 03/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/16/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3