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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376626258
Report Date: 07/20/2022
Date Signed: 07/20/2022 10:56:13 AM

Document Has Been Signed on 07/20/2022 10:56 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:HERNANDEZ, MARIA FAMILY CHILD CAREFACILITY NUMBER:
376626258
ADMINISTRATOR:MARIA HERNANDEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 203-2474
CITY:SAN DIEGOSTATE: CAZIP CODE:
92105
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
07/20/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Maria HernandezTIME COMPLETED:
10:45 AM
NARRATIVE
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On July 20th, 2022 at 9:40 AM, Licensing Program Analyst (LPA) Jo Ann Legaspi conducted an inspection to cite a violation observed during a complaint investigation. LPA advised Licensee Maria Hernandez and she granted LPA facility entry. Present in the home was the Licensee, one (1) helper and eleven (11) children; three (3) children were under 24 months. Language Link Operator 13432 provided Spanish translation services.

Licensee acknowledged children shall not sleep in their high chairs. Staff 1 (S1) began their criminal background clearance in January 2022. (See LIC 811 Confidential Names). S1 also began work in the daycare in January 2022, however their background clearance was not yet completed. As of 04/15/2022, S1's background clearance/criminal record review was still in pending status and not completed. Both Licensee and Staff 2 stated that because S1's background clearance was not completed, S1 was not left alone with children; they only cooked and cleaned. S1 told LPA that they diapered children. A witness observed children outside in the patio with S1 and S2. On 04/21/2022, LPA observed children randomly approach S1, who did not engage with the children. S1 ended facility employment on 04/21/2022; at that time, their background clearance still not been completed.

Both Licensee and S2 said S1 worked in the daycare prior to the completion of their background clearance/criminal records review. Based on conducted interviews, record reviews, and observations, the claim that an uncleared individual worked in the daycare prior to obtaining a completed criminal record clearance has been proven by the preponderance of evidence standard. California Code of Regulations, (Title 22, Division 12 Chapter 3) is being cited on the attached LIC 809D. The civil penalty of $500 has been assessed. See Civil Penalty Assessment (LIC 421BG) for detailing information.

LPA Legaspi informed Licensee Maria Hernandez that this report, dated 07/20/2022 documents one (1) Type A citation, shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE: DATE: 07/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2022
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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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: HERNANDEZ, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 376626258
VISIT DATE: 07/20/2022
NARRATIVE
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personal rights of children in care. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Also, LPA Jo Ann Legaspi informed Licensee Maria Hernandez to provide a copy of this licensing report dated 07/20/2022 that documents the Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. LPA provided Licensee with one (1) blank LIC 9224 form.

A notice of site visit was given and must remain posted for 30 days. Licensee/Appeal Rights (LIC 9098 01/16) along with a copy of this report was provided to the Licensee Maria Hernandez. Exit interview was conducted and this report was reviewed with the Licensee Maria Hernandez.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/20/2022 10:56 AM - It Cannot Be Edited


Created By: JoAnn R Legaspi On 07/20/2022 at 03:33 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: HERNANDEZ, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 376626258

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/05/2022
Section Cited
CCR
102370(d)(1)

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Criminal Records Clearance - " ... All individuals subject to a criminal record review .... shall prior to working ... in a licensed facility ... Obtain a California clearance or a criminal record exemption as required by the Department ..." This requirement was not met as evidenced by:

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LPA gave Licensee a hard copy of CCR 102370(d)(1). Licensee believed they were in compliance because S1 was neither left alone nor provided direct care to children. On 04/21/2022, S1 ended facility employment. Licensee states they will watch the CCL training video on background check requirements for caregivers located at
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Based on LPA's observations, interviews, record reviews, the Licensee did not ensure S1 had a criminal record clearance prior to working at the facility, which poses as an immediate health and safety risk to children in care.
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https://ccld.childcarevideos.org/family-child-care-providers/background-check-requirements-for-caregivers/ Licensee said they will provide LPA with a written statement describing what they learned from watching the above video & the steps will be taken when new staff are hired but do not have a completed criminal background clearance. This written statement will be given to LPA by 08/05/2022.

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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:Tulam Vu
LICENSING EVALUATOR NAME:JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:
DATE: 07/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2022


LIC809 (FAS) - (06/04)
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