376628231-1-31-2022-20-CC-JARL-CB7QR9-20220131112334

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376628231
Report Date: 01/31/2022
Date Signed: 01/31/2022 11:23:45 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:	CARROLL, EURANIKA FAMILY CHILD CARE		FACILITY NUMBER:	376628231
ADMINISTRATOR:	EURANIKA CARROLL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 282-1286
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92105
CAPACITY:	14	CENSUS: 7	DATE:	01/31/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:21 AM
MET WITH:	Euranika Carroll		TIME COMPLETED:	11:16 AM

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 January 31, 2022, at 8:21 AM, Licensing Program Analyst (LPA) Jo Ann Legaspi conducted an unannounced Annual Required Inspection and met with Licensee Euranika Carroll. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. Seven (7) children, Staff Melissa Jose and the Licensee were present in the facility during this inspection. This facility is a two (2) story, three (3) bedroom, one (1) loft and two (2) bathroom house. Licensee accompanied LPA inside and out of the facility during this inspection. The following areas used for childcare are: one (1) downstairs bathroom, the art studio and the fenced backyard. The off limits areas are the top floor. Stairs to the top floor are barricaded with child safety gates. The fire extinguisher, smoke detector, and carbon monoxide detector met requirements. Hazardous items were observed inaccessible to children during this inspection. The Licensee has available toys, play equipment and materials. The home has an available fenced backyard for outdoor activities. Licensee was reminded that continuous supervision is to be given to children whenever engaged in outdoor activities. No bodies of water were observed on the premises during the inspection. Licensee stated there are no weapons in the home. Licensee’s First Aid and CPR certifications expired in May 2021, but states is scheduled to renew the card on 02/05/2022. Staff Jose’s First Aide and CPR certifications expired in May 2019, but states is scheduled to renew it on 02/05/2022. Licensee has required immunizations. The facility roster is maintained and was reviewed. The last fire and disaster drill was conducted on 12/03/2021. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: JoAnn R Legaspi	TELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2022

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 5

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: CARROLL, EURANIKA FAMILY CHILD CARE	FACILITY NUMBER: 376628231
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/31/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(2)

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observations of the infant's facility file and statements of both the Licensee and staff, the licensee did not comply with the section cited in that there is no documented sleeping log for the infant, which poses as a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/28/2022
	Plan of Correction
1 2 3 4	LPA provided Licensee with examples of infant sleeping plan. Licensee agrees to create her own facility infant sleeping plan and document the infant's sleep. Licensee agrees to provide LPA with the infant's completed sleeping log no later than 02/28/2022.

Type B

Section Cited

CCR

102425(j)(2)(A)

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following: Labored breathing. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record reviews and interviews with both staff and the Licensee, , the licensee did not comply with the section cited above in that there is no infant sleeping log, which poses as a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/28/2022
	Plan of Correction
1 2 3 4	LPA provided Licensee with examples of infant sleeping plan. Licensee agrees to create her own facility infant sleeping plan, which will included observation for labored breathing and the infant's general condition. Licensee agrees to provide LPA with the facility's infant sleeping log no later than 02/28/2022.

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 Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: JoAnn R Legaspi	TELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2022

LIC809 (FAS) - (06/04)

Page: 2 of 5

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: CARROLL, EURANIKA FAMILY CHILD CARE	FACILITY NUMBER: 376628231
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/31/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102418(a)

Immunizations

(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record reviews, the licensee did not comply with the section cited above in that eight (8) daycare children files lacked any immunization records, which poses as a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/28/2022
	Plan of Correction
1 2 3 4	LPA provided Licensee with the LIC 811 Confidential Names, which lists all of the children whose facility files were missing their immunization records. Licensee agrees to provide LPA with copies of those children's immunization records no later than 02/28/2022.

Type B

Section Cited

CCR

102425(c)

Infant Safe Sleep

An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interviews with staff and Licensee, , the licensee did not comply with the section cited above in that the infants lacked completed LIC 9227 forms, which poses as a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/28/2022
	Plan of Correction
1 2 3 4	LPA provided Licensee with a blank LIC 9227 form. Licensee agrees to work with parents to complete this form and retain in the child's facility files. Licensee agrees to provide LPA with a copy of the completed LIC 9227 forms no later than 02/28/2022.

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 Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: JoAnn R Legaspi	TELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2022

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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: CARROLL, EURANIKA FAMILY CHILD CARE	FACILITY NUMBER: 376628231
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/31/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(c)(1)

Infant Safe Sleep

An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. This plan shall be signed and dated by the infant’s authorized representative. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record reviews and interviews with both Licensee and staff, the licensee did not comply with the section cited above in that infants lacked a completed LIC 9227 for, which poses as a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/28/2022
	Plan of Correction
1 2 3 4	LPA provided Licensee with a blank LIC 9227 form. Licensee agrees to collaborate with the infants' parents, obtain a completed LIC 9227 form and retained that completed form in the infants' facility files. Licensee agrees to provide LPA with a copy of the infants' completed LIC 9227 forms no later than 02/28/2022.

Type B

Section Cited

CCR

102425(c)(2)

Infant Safe Sleep

An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. The Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be maintained in the infant’s file and shall be available to the Department for review. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record reviews and interviews with Licensee and staff, the licensee did not comply with the section cited above in that the infants lacked completed LIC 9227 forms, which poses as a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/28/2022
	Plan of Correction
1 2 3 4	LPA provided Licensee with a blank LIC 9227 form. Licensee agrees to collaborate with the infants' parents, obtain a completed LIC 9227 form and retained that completed form in the infants' facility files. Licensee agrees to provide LPA with a copy of the infants' completed LIC 9227 forms no later than 02/28/2022.

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 Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: JoAnn R Legaspi	TELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2022

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: CARROLL, EURANIKA FAMILY CHILD CARE	FACILITY NUMBER: 376628231
	VISIT DATE: 01/31/2022

NARRATIVE

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LPA discussed the 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 as an additional resource. 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.

LPA reminded Licensee of the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, and ensure that all adults residing or working in the home have criminal background clearances or exemptions. Licensee was reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers and/or similar equipment are not allowed in daycare.

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.

Deficiencies were observed as per California Code of Regulations, (Title 22, Division 12 & Chapter 3), are being cited on the attached LIC 809-D. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Licensee Euranika Carroll.

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.

SUPERVISOR'S NAME: Tulam Vu	TELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: JoAnn R Legaspi	TELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2022

LIC809 (FAS) - (06/04)

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