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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628181
Report Date: 01/27/2020
Date Signed: 01/27/2020 06:36:59 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:CHAPA, CLAUDIA FAMILY CHILD CAREFACILITY NUMBER:
376628181
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 7DATE:
01/27/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:46 PM
MET WITH:Claudia Chapa, Licensee TIME COMPLETED:
06:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Elizabeth Rivera conducted an unannounced case management visit to the facility today with the purpose to cite deficiencies observed on today's visit. The deficiencies are based on LPAs observation and Licensee's admission. Present was the licensee and 7 day-care children including 3 infants.

See LIC 809D for cited deficiencies on today's visit. Upon receipt of a type A violation, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

Licensee wants to open day-care 24 hours and will submit updated application to LPA. The purpose of this visit is to cite for deficiencies observed today.

Signature at the bottom of this report confirms receipt.  Notice of Site Visit was posted during this visit and will remain posted for 30 days.
SUPERVISOR'S NAME: Renesha PackTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Elizabeth RiveraTELEPHONE: (619) 767-2232
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2020
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 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: CHAPA, CLAUDIA FAMILY CHILD CARE
FACILITY NUMBER: 376628181
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/27/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/27/2020
Section Cited

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(d) The home shall provide safe toys, play equipment and materials. Licensee did not provide safe equipment for infant to sleep. Upon LPA's arrival LPA observed infant sleeping in rocker which is prohibited by the
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Department. This poses an immediate risk for children in care.
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and provide LPA with picture by the end of the day.

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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: Renesha PackTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Elizabeth RiveraTELEPHONE: (619) 767-2232
LICENSING EVALUATOR SIGNATURE:
DATE: 01/27/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/27/2020
LIC809 (FAS) - (06/04)
Page: 3 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: CHAPA, CLAUDIA FAMILY CHILD CARE
FACILITY NUMBER: 376628181
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/27/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/03/2020
Section Cited

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(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency... Licensee
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Licensee did not have records for 2 children enrolled in the day care. This poses a potential risk for 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: Renesha PackTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Elizabeth RiveraTELEPHONE: (619) 767-2232
LICENSING EVALUATOR SIGNATURE:
DATE: 01/27/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/27/2020
LIC809 (FAS) - (06/04)
Page: 2 of 3