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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376626352
Report Date: 11/04/2020
Date Signed: 11/04/2020 11:21:57 AM

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:RANDOLPH, CINDY FAMILY CHILD CAREFACILITY NUMBER:
376626352
ADMINISTRATOR:CINDY RANDOLPHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 208-9206
CITY:SAN DIEGOSTATE: CAZIP CODE:
92115
CAPACITY:14CENSUS: 0DATE:
11/04/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Cindy RandolphTIME COMPLETED:
11:00 AM
NARRATIVE
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On 11/4/2020 at 10:30 AM, Licensing Program Analyst (LPA) Keturah Lane, conducted an announced Case Management Tele-Inspection visit regarding a staff member who tested positive for COVID-19 at this facility. Due to COVID-19, a tele-inspection was conducted using FaceTime to tour the facility. Licensee Cindy Randolph was present at the tele-inspection. Census at time of report was 0 children because facility is temporarily closed.

Staff member #1 (SM1) reported her boyfriend tested positive on 11/2/20 and she tested on same day. SM1 received her positive results on 11/3/20. Licensee contacted Epidemiology on 11/2/20 and again on 11/3/20 after receiving the positive results. Licensee spoke with Stephanie Quach at Epidemiology and instructed Licensee to close until 11/17/20 and that if Licensee tests positive to stay closed until 11/18/20. Licensee tested on 11/3/20 and is expecting results later today (11/4/20). Licensee stated she will update LPA accordingly. Quarantine start date is 11/3/20. The last day children were in care was 11/3/2020. Last day SM1 was at the facility was 11/2/20.

Licensee reported positive covid-19 case to Licensing on 11/3/20 at 2:05 PM through the duty line. Licensee stated she is receiving the recent PINs and information from the Department via e-mail. Census on the last day of care (11/3/20) was 11 children. On the possible exposure date of 11/2/20 there were also 11 children in care. All children were sent home by 12pm on 11/3/20. Parents were notified of the positive Covid-19 exposure through phone calls on 11/3/20.

(continued on LIC-809C...)
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Keturah LaneTELEPHONE: (619) 767-2223
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2020
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: RANDOLPH, CINDY FAMILY CHILD CARE
FACILITY NUMBER: 376626352
VISIT DATE: 11/04/2020
NARRATIVE
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Licensee stated that she will have a staff meeting and go over the safety measures with staff members. Licensee will contact JanPro (cleaning company) to have the house disinfected with a steam Covid-19 cleaning process. Licensee has been in good communication with all families and they are following safety procedures. Licensee completed tele-visit to review COVID-19 guidelines with LPA Ma on 9/24/20.

LPA Lane received updated children’s roster (LIC9040) and Unusual Incident Report LIC624b via e-mail from Licensee on 11/4/20. LPA Lane will continue to follow up with Licensee on the facility's situation.

An exit interview was conducted with the Licensee. Appeal Rights were discussed and provided. Facility was advised to post the Notice of Site Visit for 30 days. A copy of the report, appeal rights and notice of site visit will be e-mailed to the facility and Licensee was advised that acknowledgement of the receipt of the report is to be received within twenty-four hours.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Keturah LaneTELEPHONE: (619) 767-2223
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2020
LIC809 (FAS) - (06/04)
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