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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700613
Report Date: 04/20/2020
Date Signed: 04/20/2020 01:59:05 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:CHILDREN'S VILLAGES CHILD DEVELOPMENT CTR.-INFANTFACILITY NUMBER:
376700613
ADMINISTRATOR:DANIEL ROCHAFACILITY TYPE:
830
ADDRESS:2506 EL CAMINO REALTELEPHONE:
(760) 434-5854
CITY:CARLSBADSTATE: CAZIP CODE:
92008
CAPACITY:14CENSUS: 5DATE:
04/20/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Jordan JonesTIME COMPLETED:
01:30 PM
NARRATIVE
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On 04/20/2020 at 1:15pm, Nancy Diaz, LPA conducted a case management teleconference with Lead staff, Jordan Jones. This inspection was conducted via tele conference due to the COVID-19 outbreak.

A tour of the facility was conducted with Jordan Jones. Observed present in the infant room were five (5) infants with staff Tess Mackinen, Jazzlyn Ellison-Gomez and Melissa Sanchez.

Type B deficiency was cited today. A civil penalty was also assessed.

A copy of this report, Notice of Site Visit and appeal rights (LIC 9058 01/16) was reviewed and will be e-mailed to the Licensee and Licensee was advised that acknowledgement of the receipt of this report is to be received within twenty-four hours. Licensee was advised to post the Notice of Site Visit for 30 days and failure to keep the posting will result in $100 civil penalty.

Please see Page 2 for deficiency citation.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2020
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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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: CHILDREN'S VILLAGES CHILD DEVELOPMENT CTR.-INFANT
FACILITY NUMBER: 376700613
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/20/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/20/2020
Section Cited

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CRIMINAL RECORD CLEARANCE. All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: Request a transfer of a criminal record clearance as specified in Section 101170(f) or

This requirement was not met as evidenced by:
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LPA reviewed the fingerprint database and found that two staff fingerprint clearances - Joy Lightfoot (employed 3/3/20) and Christina Paden (employed 3/16/20) were not associated to the facility.
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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: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:
DATE: 04/20/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/20/2020
LIC809 (FAS) - (06/04)
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