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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376626751
Report Date: 12/21/2020
Date Signed: 12/22/2020 08:50:12 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:FAJARDO, TANNIA FAMILY CHILD CAREFACILITY NUMBER:
376626751
ADMINISTRATOR:TANNIA FAJARDOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 215-6159
CITY:SAN DIEGOSTATE: CAZIP CODE:
92104
CAPACITY:14CENSUS: 0DATE:
12/21/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Tannia FajardoTIME COMPLETED:
04:30 PM
NARRATIVE
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On 12/21/2020 at 01:15 PM LPA Dana Stevens conducted an unannounced Case Management tele-inspection for the purpose of following up on an unusual incident that occurred on or about 02/12/2020 and was reported by Licensee Tannia Fajardo on 09/24/2020. LPA Stevens met with licensee, Tannia Fajardo, via FaceTime per CDPH guidelines for the COVID 19 State of Emergency. No children were present during this inspection due to the holiday break.
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On 02/18/2020 Licensee terminated the employment of assistant, Staff #1, for making a video of Child #1 being hit in succession by Child #2, Child #3 and Child #4, which was a violation of the children’s personal rights. At the time, Staff #1 was alone with 8 children total, 1 infant and 7 children ages 2-4. Facility was operating out of ratio. The incident occurred on 02/12/2020 and Licensee was made aware of the video on 02/13/2020. Licensee did not report the incident to daycare parents until late August/early September and did not report the incident to the Licensing Department until 09/24/2020. Licensee did not meet reporting requirements.








SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Dana StevensTELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2020
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 4
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: FAJARDO, TANNIA FAMILY CHILD CARE
FACILITY NUMBER: 376626751
VISIT DATE: 12/21/2020
NARRATIVE
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Title 22 Deficiencies have been cited on the attached LIC 809D. Upon receipt of Type A citations, facility shall post and provide copies of the LIC 809D for parents/guardians of children currently in care and for parents/guardians of newly enrolled children for the next 12 months. Facility must also keep the signed LIC 9224, Acknowledging Receipt of Licensing Reports LIC 809D in each child's file.

LPA reviewed and discussed this report with the Licensee and Licensee was informed she will be receiving notification to participate in a Non-Compliance Conference to develop a Compliance Plan.

A copy of this report, LIC 811, appeal rights, and Notice of Site Visit were provided to licensee via email. Licensee understands that an email acknowledgement of the report must be received within 24 hours.


SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Dana StevensTELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2020
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: FAJARDO, TANNIA FAMILY CHILD CARE
FACILITY NUMBER: 376626751
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/21/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/04/2021
Section Cited

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102416.5(b)(3)(a)Staffing Ratio and Capacity…the maximum number of children…shall be one of the following:...More than six and up to eight...only if the criteria in Section 1597.44 of the Health and Safety Code are met...at least one child is enrolled in and attending kindergarten or elementary school and a second child is at least six years of age. This requirement was not met as evidenced by,

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Based on LPA’s observation of the video provided by Licensee and based on Licensee’s documentation on the Unusual Incident Report, facility was found to be out of ratio which poses an immediate risk to the Health and Safety of children in care.
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Licensee will watch the video "How many children can attend a Family Child Care Home" at department website:ccld.childcarevideos.org, and submit a written plan to LPA by 01/04/2021 of how she will ensure her facility maintains correct ratio and capacity,and how she will train staff.
Type A
01/08/2021
Section Cited

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102423 (a)(1) Personal Rights Each child receiving services... shall have certain rights that shall not be waived...These rights include, but are not limited to, the following: To be treated with dignity in his/her personal relationship with staff and other persons. This requirement was not met as evidenced by,
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LPA's observation of the video in which child #1 was hit in succession by Child #2, Child #3 and Child #4, without intervention by Staff #1, a violation of the children’s personal rights which poses an immediate risk to the Health and Safety of children in care.
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Licensee will review informational video on Children’s Personal Rights at the department website: ccld.childcarevideos.org, and submit a writtent summary to LPA by 01/08/2021 that includes how she will train staff.
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 VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Dana StevensTELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:
DATE: 12/21/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/21/2020
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: FAJARDO, TANNIA FAMILY CHILD CARE
FACILITY NUMBER: 376626751
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/21/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/15/2021
Section Cited

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102416.2(b)(3)(C)Reporting Requirements..."A report shall be made to the Department…following the occurrence during the operation of a family day care home of any of the following events:Any unusual incident... that threatens the physical or emotional health or safety of any child." This requirement was not met as evidenced by,

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Based on Licensee’s verbal report of the incident to LPA on 09/24/2020 and licensee’s submission of the written report (LIC 624b) on 09/28/2020, Licensee did not meet the requirement of reporting an unusual incident within 24 hours to the Licensing Department which poses a potential Health and Safety Risk to children in care.


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Type B
01/15/2021
Section Cited

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102416.2(f) Reporting Requirements As soon as possible but no later than the same business day, the licensee shall notify a child's parent or authorized representative... as specified in Health and Safety Code Section 1597.467(a).This requirement was not met as evidenced by,

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Based on LPA interviews with parents, Licensee’s own admission and documentation on the Unusual Incident Report, Licensee did not inform the parents of the children involved in the incident on the same business day which poses a potential 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: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Dana StevensTELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:
DATE: 12/21/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/21/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4