376626126-6-28-2023-20-CC-LGAO-CT934A-20230628175450

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376626126
Report Date: 06/28/2023
Date Signed: 06/28/2023 08:03:45 PM

Document Has Been Signed on 06/28/2023 08:03 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:	NIZIGIYIMANA, JEANNE FAMILY CHILD CARE		FACILITY NUMBER:	376626126
ADMINISTRATOR:	JEANNE NIZIGIYIMANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 383-1331
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92105
CAPACITY:	14	CENSUS: 4	DATE:	06/28/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Jeanne Nizigiyimana		TIME COMPLETED:	06:00 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 June 28, 2023, at 3:00 PM, Licensing Program Analyst (LPA), Luigi Gargaro, conducted an unannounced annual required inspection and met with the licensee, Jeanne Nizigiyimana. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. Only the licensee and her own four children were present in the facility during this inspection as the attending day care children left earlier in the day. This facility is a one floor, two bedroom, one bathroom house. Licensee accompanied LPA inside and out of the facility during this inspection. The following areas used for child care are: the kitchen, the living room, the second bedroom and the bathroom. Off limits area is the first (master) bedroom and is made inaccessible through use of a door knob cover that is installed on its entry door handle. The home has an operational wall heating unit that the licensee states she does use. The licensee has a removable metal gate that she uses as a barricade to prevent children from having access to the unit during child care hours whenever the heater is being used. The fire extinguisher, smoke detector, and carbon monoxide detector met requirements. All hazardous items were inaccessible to children. The licensee has toys, play equipment and materials available. The home has a fenced backyard available for outdoor activities. The yard contains two sheds for the licensee's personal items. The sheds are made off limits to children in care with the use of locking door handles. No bodies of water observed on the premises during the inspection. 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 criminal record and child abuse clearances or exemptions. Licensee’s First Aid and CPR certifications expire on 06/17/25. Licensee has required immunizations. Licensee is currently exempt from Mandated Reporter Training. Facility roster and fire and disaster drills have not been maintained.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

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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Document Has Been Signed on 06/28/2023 08:03 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: NIZIGIYIMANA, JEANNE FAMILY CHILD CARE	FACILITY NUMBER: 376626126
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/28/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(2)(A)

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following: Labored breathing. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in as she states though she checks on the sleeping infant she has in care she has not been documenting her checks which poses/posed a potential health, safety or personal rights risk to children in care.
	POC Due Date: 07/10/2023
	Plan of Correction
1 2 3 4	Licensee was provided with a sample safe sleep log and understands that from this point forward she is required to log napping times and status for any infant in care. She states she will also submit a sample of a log for child #2 for the period of 06/29/23 - 07/07/23 to analyst on 07/10/23 to complete the correction.

Type B

Section Cited

CCR

102421(b)

Child's Records

(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required in Section 102417(g)(7). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above as she has not maintained records for any of her day care children which poses/posed a potential health, safety or personal rights risk to children in care.
	POC Due Date: 07/10/2023
	Plan of Correction
1 2 3 4	Analyst provided licensee with a sample records packet for her to copy and provide to the parents to complete. Once returned to her, licensee states she will submit one record packet from each of the two families she has in care to analyst by 07/10/23 to complete the correction.

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: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/28/2023 08:03 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: NIZIGIYIMANA, JEANNE FAMILY CHILD CARE	FACILITY NUMBER: 376626126
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/28/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(8)

Operation of A Family Child Care Home

(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above as she did not have a current roster of day care children which poses/posed a potential health, safety or personal rights risk to chldren in care.
	POC Due Date: 07/10/2023
	Plan of Correction
1 2 3 4	Analyst provided licensee with a blank roster and licensee states she will complete it and send a copy to him with her other pending correction documents, by 07/10/23, to clear the deficiency.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

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: NIZIGIYIMANA, JEANNE FAMILY CHILD CARE	FACILITY NUMBER: 376626126
	VISIT DATE: 06/28/2023

NARRATIVE

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Licensee currently has one day care infant who is old enough to climb out of a crib and does not sleep in a crib or play yard any longer. The provider states she physically checks on sleeping infants every 15 minutes but has not been maintaining a safe sleep log. The provider places infants up to 12 months of age on their backs for sleeping. Analyst provided licensee with a copy of the safe sleep regulations for her to review at a future date.

LPA provided and 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 daycare. 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.

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. Unusual Incident Reports may be e-mailed to: SDIncidentReports@dss.ca.gov

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.

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

An exit interview was conducted with the licensee. The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.

LPA provided notice of site visit and observed it being posted at the facility.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

LIC809 (FAS) - (06/04)

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