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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376627405
Report Date: 06/11/2024
Date Signed: 06/11/2024 01:31:10 PM


Document Has Been Signed on 06/11/2024 01:31 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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108



FACILITY NAME:JIMENEZ, MARIA FAMILY CHILD CAREFACILITY NUMBER:
376627405
ADMINISTRATOR:MARIA JIMENEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(914) 294-7349
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY:14CENSUS: 10DATE:
06/11/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Devaki Garcia and Maria JimenezTIME COMPLETED:
01:45 PM
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On 6/11/2024, at 10:20am, Licensing Program Analyst (LPA), Vicky Williamson conducted an unannounced annual inspection. LPA met with Licensee's Assistant Devaki Garcia and disclosed the purpose of the inspection. Upon LPA's arrival there were nine (9) children present, one of who is an infant. The nine (9) children were left alone with licensee's assistant, Devaki Garcia. LPA spoke with licensee via phone and she stated due to an emergency she had to leave the facility. Licensee, Maria Jimenez arrived to the facility at 11:00am with her minor daughter. Days and hours of operation are Monday through Friday from 7:30am - 4:30pm.

This is a two story three bedrooms, two bathroom home. LPA accompanied by assistant toured the inside and outside of the home. The following areas are used for childcare: living room/playroom, bathroom # 2 and the backyard is used for outdoor activities which includes a portion of the patio. Off limits areas include kitchen, bedroom #1 and bedroom #2 (both located downstairs), bathroom #1 (located inside of kitchen), additional portion of the patio in the backyard separated by safety gates, garage, two storage rooms and the entire upstairs (bedroom #3 (master), bathroom #3, office). Garage is made inaccessible through the use of gate and door knob cover. Off limit areas made inaccessible to day care children by utilizing locks and safety gates. Licensee was reminded to provide supervision at all times when utilizing backyard for outdoor play.

LPA advised the Licensee that prior to making alterations or additions to the home or grounds, the Licensee shall notify the Department of the proposed change.

The fire extinguisher, smoke and carbon monoxide detectors meet requirements and are operational. Poisons, detergents, cleaning compounds, medications and other hazardous items were made inaccessible. Licensee has children's toys, play equipment and books available. Licensee has a home phone and a working cell phone. The home has a fireplace located in the living room/playroom that is properly secured. The stairs in the home were properly barricaded. See LIC 809C Continuation...
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Vicky WilliamsonTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:
DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/11/2024
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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: JIMENEZ, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 376627405
VISIT DATE: 06/11/2024
NARRATIVE
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Licensee stated there are no bodies of water on the premises. Licensee stated there are no firearms, ammunition or other weapons in the home.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Pediatric CPR/First Aid certification for licensee is valid through 1/14/2025 and for assistant 9/30/2025. Licensee and assistant have the required immunization records on file. Mandated Reporter training certification for licensee is valid through 5/29/2026 and for assistant 9/4/2025. LPA informed licensee to ensure the mandated reporter training is completed once every two years. LPA observed the required documents posted. A sample of children’s files were reviewed and were determined to be complete. The last fire drill was conducted on 3/20/2024 and disaster drill on 4/23/2024.

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.

LPA discussed safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep
LPA reviewed PIN 20-24-CCP regarding Safe Sleep with licensee. Licensees stated that she understood.

LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
See LIC 809C Continuation...
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Vicky WilliamsonTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: JIMENEZ, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 376627405
VISIT DATE: 06/11/2024
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LPA and licensee discussed and reviewed the following: Report suspected child abuse and neglect, form LIC 311D, maintaining children’s records according to regulation, posting required forms. Licensee is reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers and/or similar equipment are not allowed in daycare. Licensee was also provided information regarding SIDS, Lead Exposure and Shaken Baby Syndrome.


LPA discussed and provided Licensee with the following: childcare 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed - related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

LPA and licensee discussed the maximum number of children for whom care shall be provided when there is an assistant in the home, including children under age 10 who live in the licensee's home shall be either: Twelve (12) children with no more than four of whom may be infants and 8 older children over the age of 2 years or Fourteen (14) children, with no more than three infants (birth to 24 months) and at least two of the children with 1 child enrolled in kindergarten and 1 child at least six years of age with landlord consent (LIC 9149).



To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

See LIC 809C Continuation...
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Vicky WilliamsonTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: JIMENEZ, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 376627405
VISIT DATE: 06/11/2024
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Per California Code of Regulations, Title 22, Division 12, Chapter 3, deficiency is being cited. See the attached LIC 809D.

During the exit interview, the Licensee, Maria Jimenez, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A copy of this report along with Appeals Rights, were provided. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the Licensee, Maria Jimenez.

SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Vicky WilliamsonTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 06/11/2024 01:31 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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108


FACILITY NAME: JIMENEZ, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 376627405

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/11/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.5(e)
Staffing Ratio and Capacity
(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in 9 out of 9 persons in that licensee's assistant was left alone with 9 children which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/18/2024
Plan of Correction
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Licensee arrived to the facility within 25 minutes after phone call with LPA. Licensee stated that she is aware of the ratio and due to an emergency had to leave the facility. Licensee stated that she will submit a plan of correction stating how she will comply with capacity requirements when only one employee is present at the facility. Licensee stated that she will submit plan correction to the SDRO, no later than 6/18/2024.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Vicky WilliamsonTELEPHONE: (619) 767-2201
LICENSING EVALUATOR SIGNATURE:
DATE: 06/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/11/2024
LIC809 (FAS) - (06/04)
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