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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628484
Report Date: 10/28/2021
Date Signed: 11/01/2021 06:46:22 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:BEILESON, ELSA & BEILESON, OSCAR FAMILY CHILD CAREFACILITY NUMBER:
376628484
ADMINISTRATOR:E. BEILSON & O. BEILESONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 608-7140
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY:14CENSUS: 4DATE:
10/28/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Elsa Beileson & Oscar BeilesonTIME COMPLETED:
07:50 PM
NARRATIVE
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On 10/28/21 at 3:45PM, Licensing Program Analysts (LPAs), Casey Gulley and LPA Claudia Amador conducted an unannounced case management inspection to follow up on multiple incidents which occurred at the facility in the month of September 2021.

On 09/04/21, law enforcement responded to the facility due to adult resident engaging in unusual behavior, including throwing items at the facility. On 09/05/21, law enforcement and emergency services responded to a medical emergency at the facility. On 09/10/21, Licensee Elsa and adult resident engaged in verbal altercation in which adult resident made life threatening remarks. On 09/18/21 Licensee Elsa Beileson engaged in a physical altercation with an adult resident, which resulted in injuries to Licensee Elsa. On or about 09/26/21 Licensee Elsa and adult resident engaged in a verbal altercation in which adult resident again made life threatening remarks, which resulted in adult resident taken into custody.

Facility, licensing and police records were reviewed. According to police records, Licensee Elsa declined offers to obtain protective orders on multiple occasions. According to facility records, multiple daycare children were present during each incident. During interviews conducted, both Licensees omitted and/or minimized information about the incidents. Licensees did not report the incidents that occurred on 09/04/21, 09/05/21, 09/10/21, or 09/26/21 to licensing as required.

(continued on LIC 809-C)
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Casey GulleyTELEPHONE: (619) 767-2216
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
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 4
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: BEILESON, ELSA & BEILESON, OSCAR FAMILY CHILD CARE
FACILITY NUMBER: 376628484
VISIT DATE: 10/28/2021
NARRATIVE
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Licensees have engaged in conduct that makes their facility unsafe. They have not accurately reported or created a plan to address the safety issues. Based on information obtained Licensees and adult resident have engaged in conduct inimical to the health, morals, welfare, and safety of others, therefore Health and Safety Code 1596.885(c) is being cited on the attached LIC 809-D.

During todays inspection, Licensee Elsa was served with an Immediate Exclusion Order for Adolfo Tapia Vivanco. Licensee Elsa was also substitute served the Immediate Exclusion Order for Adolfo Tapia Vivanco as his current whereabouts is unknown. Licensees were provided the Family Child Care Home Addendum to Notification of Parent's Rights (Regarding Removal/Exclusion), LIC-995B in English/Spanish. Licensees were advised that the form needs to be provided to parents and copy is to be kept in children's records.

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. A copy of the Fact Sheet - Child Care Parent Notification Requirements and a copy of LIC 9224 was given to licensee.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

This is an electronic version of an original handwritten report that was completed and signed by the Department on 10/28/21 at 7:50pm.
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Casey GulleyTELEPHONE: (619) 767-2216
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: BEILESON, ELSA & BEILESON, OSCAR FAMILY CHILD CARE
FACILITY NUMBER: 376628484
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/28/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/29/2021
Section Cited

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Health and Safety Code Section 1596.885(c): Conduct which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of this state.

This requirement is not met as evidenced by:
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Based on interviews and records reviewed, on multiple incidents licensees and adult resident engaged in conduct inimical to the health, morals, welfare and safety of others. Licensees omitted and/or minimized information about the incidents. This poses as an immediate health and safety risk to children in care.
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A Non-Compliance Conference is scheduled for the near future.

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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: 10/28/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/28/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: BEILESON, ELSA & BEILESON, OSCAR FAMILY CHILD CARE
FACILITY NUMBER: 376628484
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/28/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/12/2021
Section Cited

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Reporting Requirements 102416.2(b) -The licensee shall report to the Department any of the events as specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C) that occur during the operation of the family child care home.

This requirement is not met as evidenced by:
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Based on records reviewed, Licensees did not report multiple incidents that occured at the facilty to the department as required. This poses as a potential health and safety risk to 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: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Casey GulleyTELEPHONE: (619) 767-2216
LICENSING EVALUATOR SIGNATURE:
DATE: 10/28/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/28/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4