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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628204
Report Date: 12/23/2019
Date Signed: 12/23/2019 11:21:38 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:RODRIGUEZ, MAYRA & WILFREDO FAMILY CHILD CARE HOMEFACILITY NUMBER:
376628204
ADMINISTRATOR:MAYRA & WILFREDOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 305-5400
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY:14CENSUS: 3DATE:
12/23/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Wilfredo RodriguezTIME COMPLETED:
11:30 AM
NARRATIVE
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LPA toured the facility and verified that all proper documentation was properly posted, LPA discussed with licensee issue pertaining to Reporting Responsibilities. During a review of process followed by licensee, when licensee discovered a child’s parent was failing to meet the child’s health needs, licensee failed to report to proper outside agencies to inquire on the child’s home environment and well-being as required, by being a mandated reporter. Even though licensee was trying to work with the parent, who may have been neglectful of her child’s health needs, licensee failed to report as a mandated reporter.

LPA toured the home and verified the home was properly childproofed and all other paperwork was in order and properly posted, a 'B' type deficiency is cited for failure to report. LPA provided licensee copy of licensing regulations pertaining to Reporting Responsibilities during the visit.

A copy of this report shall be maintained in the facility for public review.
SUPERVISOR'S NAME: Joe CarrascoTELEPHONE: (619) 767-2243
LICENSING EVALUATOR NAME: Armando LocanoTELEPHONE: (619) 767-2221
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2019
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 2
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: RODRIGUEZ, MAYRA & WILFREDO FAMILY CHILD CARE HOME
FACILITY NUMBER: 376628204
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/23/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/23/2019
Section Cited

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102416.2 Reporting Requirements(c) In addition to the events specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C), the licensee shall report the following events to the Department:

(1) Any suspected child abuse or neglect, as defined in Penal Code Section 11165.6, of any child in care, in addition to reporting requirements pursuant to Penal Code Section 11166.
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Licensee failed to report possible neglect to a daycare child outside of the daycare environment, potentially affecting the child’s well-being, to proper outside agencies for investigation. Even though licensee was trying to work with the child’s parent and there were no issues of neglect on the licensee’s part or in the daycare facility, licensee is a mandated reporter. This was evidenced, when it was verified through documentation, child’s parent was failing to meet the child’s health, licensee failed to report to proper outside agencies to inquire on the child’s home environment and well-being as required.
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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: Joe CarrascoTELEPHONE: (619) 767-2243
LICENSING EVALUATOR NAME: Armando LocanoTELEPHONE: (619) 767-2221
LICENSING EVALUATOR SIGNATURE:
DATE: 12/23/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/23/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2