376627917-9-24-2019-51-CC-ERED-BGBRBD-20190924125233

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376627917
Report Date: 09/24/2019
Date Signed: 09/24/2019 12:52:40 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:	PAGAN, NINA FAMILY CHILD CARE		FACILITY NUMBER:	376627917
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 6	DATE:	09/24/2019
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	11:13 AM
MET WITH:	Nina Pagan		TIME COMPLETED:	01:10 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	Licensing Program Analyst (LPA) Elise Read conducted an unannounced case management inspection for the purpose of a capacity increase with the licensee. The home was toured and inspected to ensure an environment safe for the care and supervision of children. Present during the time of inspection was the licensee, licensee's mother, licensee's father, and 6 day care children. The fire clearance was granted on 09/10/2019. The fire extinguisher, carbon monoxide detector, and smoke detector (all located in the kitchen) 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. First Aid and CPR certifications for licensee and licensee's mother, Ann Naibova, expire on 03/02/2021. Licensee meets immunizations requirements and Mandated Reporter Training AB 1207 was completed on 11/20/2018. Applicant will be using the following rooms for childcare: daycare room and hallway bathroom. The following areas will be off limits: kitchen, dining room, and all bedrooms in the home. The garage is also off limits and kept inaccessible through the use of a door knob cover. The applicant has sufficient toys and equipment available. The home has a fenced backyard available for outdoor activities. Licensee will be converting the side gate of the home in to the main entrance for child care parents. Licensee has doorbell installed for parents to use next to the side gate. LPA explained to licensee that when licensee converts side gate to be used for daycare, she will need to make the outside air conditioner unit inaccessible to children. At this time, the side gate entrance and air conditioner unit are completely inaccessible to children by the use of a gate.

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Elise Read	TELEPHONE: (619) 767-2240
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2019

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: PAGAN, NINA FAMILY CHILD CARE	FACILITY NUMBER: 376627917
	VISIT DATE: 09/24/2019

NARRATIVE

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The following information was reviewed with the applicant: information on reporting requirements for suspected child abuse and unusual incidents, children’s records, immunizations, adults living or working in the home and related civil penalties, shaken baby syndrome, Safe Sleep Regulation/SIDS, and Lead Exposure. Applicant was reminded that corporal punishment, smoking, walkers, exersaucers, bouncy seats 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 discussed and provided licensee with the following: Child Care Advocates - email address childcareadvocatesprogram@dss.ca.gov and phone number (916) 654-1541.In addition, for common questions or questions regarding licensing requirements to contact the Child Care Licensing duty line at 619-767-2248.

No deficiencies are cited. No corrections are needed; a license for 14 will be issued upon final file review.

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Elise Read	TELEPHONE: (619) 767-2240
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2019

LIC809 (FAS) - (06/04)

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