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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628484
Report Date: 09/28/2021
Date Signed: 09/28/2021 03:19:41 PM


Document Has Been Signed on 09/28/2021 03:19 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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108



FACILITY NAME:VIVANCO, ELSA & BEILESON, OSCAR FAMILY CHILD CAREFACILITY NUMBER:
376628484
ADMINISTRATOR:E. VIVANCO & O. BEILSONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 608-7140
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY:14CENSUS: 6DATE:
09/28/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Elsa Vivanco TIME COMPLETED:
03:30 PM
NARRATIVE
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On September 28, 2021 at 10:15 am, Licensing Program Analyst (LPA) Casey Gulley conducted an unannounced case management inspection in response to emergency officials presence at the facility. The facility self reported the incident to the Department. There were six (6) children and three staff (3) present. LPA met with licensee Elsa Vivanco and discussed the purpose of the inspection. Angel Tapi Vivanco assisted with translation. LPA Gulley interviewed licensee, staff members and children.

Upon touring the facility LPA Casey Gulley observed a pool located in the back yard of the facility. Self-latching gate was also not able to self-latch or self-closing at all distances witch poses as an immediate threat to children in care.

California Code of Regulations, (Title 22, Division 12 & Chapter 3), are being cited on the attached LIC 809-D.

Upon Receipt, 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.

An exit interview was conducted with Licensee, Elsa Vivanco. The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. Child Care Parent Notification Requirements and a copy of LIC 9224 was given to licensee.

LPA provided notice of site visit and observed it being posted at the facility.
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Casey GulleyTELEPHONE: (619) 767-2216
LICENSING EVALUATOR SIGNATURE:
DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2021
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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Document Has Been Signed on 09/29/2021 04:52 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 09/29/2021 11:57 AM

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: VIVANCO, ELSA & BEILESON, OSCAR FAMILY CHILD CARE
FACILITY NUMBER: 376628484

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/28/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
09/29/2021
Section Cited

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(g)(5) All licensees shall ensure the inaccessibility of pools...(A)... gates shall swing away from the pool, self-close and have a self-latching device located no more than six inches from the top of the gate.


This requirement is not met as evidenced by:
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Based on observation, Licensee did not ensure pool entry door is self latching and self closing whijch poses as an immediate health and safety threat to children in care.

This is an amended version of the originial report created on 9/28/21.



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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: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Casey GulleyTELEPHONE: (619) 767-2216
LICENSING EVALUATOR SIGNATURE:
DATE: 09/28/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2021
LIC809 (FAS) - (06/04)
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