<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376627090
Report Date: 09/21/2021
Date Signed: 09/21/2021 12:51:29 PM

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:POLUS, RITA FAMILY CHILD CAREFACILITY NUMBER:
376627090
ADMINISTRATOR:RITA POLUSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 715-7898
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY:14CENSUS: 0DATE:
09/21/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Rita PolusTIME COMPLETED:
12:15 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 9/21/21 at 9:30 AM, Licensing Program Analyst (LPA) Adrian Mangina conducted an unannounced Annual inspection with the Licensee. Upon arrival, LPA met with Licensee, Rita Polus. Licensee's requested that her friend provide translation over the phone. Language Link Translator Kumanji #12325 provided translation for the reading of the report. The one-story three bedroom two bathroom home was toured and inspected to ensure an environment safe for the care and supervision of children. There was no one else present in the home and no children in care. Proper supervision and ratios were observed. The 3A10BC fire extinguisher, and combination carbon monoxide detector/smoke detector meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. There are no bodies of water on the property. Licensee states that 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 May 31.2023. Licensee and staff meet immunization requirements. Licensee states that her husband is her helper in the child care. Mandated Reporter Training was waived due to Licensee’s and helper’s first language is not English. LPA reviewed children files. Licensee has no file for twelve of fifteen children. Licensee maintains files for three of fifteen children but the emergency consent forms for those children are not signed by the parent. Licensee reminded to maintain child records for each child in care. Licensee stated that she does not have a current roster of children in her care. Licensee reminded to keep roster of children in her care current. Last disaster drill 8/12/21.

Licensee has provided adequate space for the children to eat, sleep and play within the home. Areas used for child care include: living room, kitchen, dining area, bedroom #1 and bathroom#1. Off limits areas include: bedroom #2, bedroom#3, and bathroom #2 and side yards and are inaccessible through use of doorknob covers and gates. There is a working phone at the facility. The licensee has sufficient safe age appropriate, toys and equipment available. The home has a fully fenced backyard available for outdoor activities.
(continued on LIC812 page 2)
SUPERVISOR'S NAME: Renesha PackTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Adrian L ManginaTELEPHONE: (619) 767-2209
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2021
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
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: POLUS, RITA FAMILY CHILD CARE
FACILITY NUMBER: 376627090
VISIT DATE: 09/21/2021
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
26
27
28
29
30
31
32
Provider is hereby reminded of the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, ensure that all adults living or working in the home have criminal background clearances associated to the facility, corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov. LPA Mangina reviewed Covid-19 guidelines with Licensee and provided Covid-19 resources. LPA Mangina directed Licensee to website: https://www.cdss.ca.gov/inforesources/community-care-licensing to receive important updates and information.

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.

See LIC 809D for Deficiencies cited during visit.

An exit interview was conducted with the Licensee. The Licensee was provided a copy of their appeal rights (LIC 9058) along with a copy of this the report (LIC809) their signature on this form acknowledges receipt of these rights. LPA observed LIC 9213 (Notice of Site visit) was posted during today's visit. Notice of Site Visit must remain posted for 30 days.
SUPERVISOR'S NAME: Renesha PackTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Adrian L ManginaTELEPHONE: (619) 767-2209
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: POLUS, RITA FAMILY CHILD CARE
FACILITY NUMBER: 376627090
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/21/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/21/2021
Section Cited

1
2
3
4
5
6
7
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 was not met as evidenced by:
8
9
10
11
12
13
14
Based on observation, interview and file review, Licensee does not have signed emergency consent forms for children #'s 2,3,and 4 and no files for children 1,5,6,7,8,9,10,11,12,13,14,15.
8
9
10
11
12
13
14
Type B
10/21/2021
Section Cited

1
2
3
4
5
6
7
 Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.
This requirement was not met as evidenced by:
8
9
10
11
12
13
14
Based on file review and Licensee statement Licensee does not have have a roster of the current kids in her care.
8
9
10
11
12
13
14
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: Renesha PackTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Adrian L ManginaTELEPHONE: (619) 767-2209
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3