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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 136610630
Report Date: 04/01/2025
Date Signed: 04/01/2025 01:11:07 PM

Document Has Been Signed on 04/01/2025 01:11 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
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:RIVAS, RUBITH FAMILY CHILD CAREFACILITY NUMBER:
136610630
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
04/01/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Licensee Rubith Rivas TIME VISIT/
INSPECTION COMPLETED:
01:15 PM
NARRATIVE
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On 04/01/2025, at 10:45 AM, Licensing Program Analyst (LPA) Julieta Abrego conducted a capacity increase inspection. Licensee Rubith Rivas was advised of the inspection’s purpose and granted LPA facility entry. The inspection’s purpose is to ensure that the home follows standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. Present in the home was the Licensee, three (3) children and one (1) staff. This single story, four bedrooms, two bath home was toured and inspected. The hours of operation are Monday through Sunday, 3:00 a.m. to 2:30 a.m.

On 01/14/2025, Licensee submitted an application (LIC 279) requesting a capacity increase. The Fire Safety Inspection Request (STD 850) was approved by the local fire marshal on 01/17/2025 for fourteen (14) children.

Daycare areas are the following: living room, dining room, kitchen, bedroom #1, hallway bathroom and back yard. Off limit areas include Master bedroom, Master bathroom, bedroom #2 & #3 and garage. The off-limits areas are inaccessible using door locks and safety gates.

The fire extinguisher, smoke detector, and carbon monoxide detector met the requirements. All hazardous items were inaccessible to children. The licensee has toys, play equipment, and materials available. The licensee uses the backyard for outdoor activities. No bodies of water were observed on the premises during the inspection. The licensee stated there are no firearms or weapons in the home.

The Licensee has provided proof of control of property. The licensee owns the property, they can operate with a maximum capacity of 14 children.
NAME OF LICENSING PROGRAM MANAGER: Cynthia Biszant
NAME OF LICENSING PROGRAM ANALYST: Julieta Abrego
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/01/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: RIVAS, RUBITH FAMILY CHILD CARE
FACILITY NUMBER: 136610630
VISIT DATE: 04/01/2025
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The Licensee and LPA reviewed the Ratio/Capacity Worksheet for a large family childcare home. The Licensee acknowledged that if no assistant provider is present at a Large Family Child Care Home, then the Licensee shall comply with the capacity requirements for a Small Family Child Care Home. Licensee has submitted the proper documentation for two assistants and have already completed the background clearance prior to their initial presence in a Family Child Care home. The helpers have a current pediatric 1st Aide/CPR card, Mandated Reporter Training completion certificate, documentation of their necessary vaccinations and medical clearance. Licensee acknowledges that their assistant's records will be maintained in the daycare for review by the Department.

The Licensee and adult residents in the home have criminal record clearances and/or exemptions on file. Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and adults who have contact with children, 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.



In the areas that were evaluated, no deficiencies were observed. Licensure for a capacity of fourteen (14) children is approved effective today 04/01/2025. A new license will be generated and mailed to the provider.

Notice of site visit was given to the licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Exit interview was conducted and report was reviewed with the Licensee Rubith Rivas.
NAME OF LICENSING PROGRAM MANAGER: Cynthia Biszant
NAME OF LICENSING PROGRAM ANALYST: Julieta Abrego
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2025
LIC809 (FAS) - (06/04)
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