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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100648
Report Date: 03/03/2021
Date Signed: 03/03/2021 11:52:40 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:GRIJALVA, VANESSA FAMILY CHILD CAREFACILITY NUMBER:
376100648
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
03/03/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Applicant, Vanessa GrijalvaTIME COMPLETED:
11:37 AM
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Licensing Program Analyst (LPA), Jennifer Lott, conducted an announced Pre-Licensing Inspection via Virtual Visit due to COVID-19 restrictions. LPA met with applicant, Vanessa Grijalva, identified herself, and disclosed the purpose of the virtual call. The applicant has applied for a capacity of eight (8). The home consists of one (1) bedroom and one (1) bathroom. The applicant will be using the following areas for daycare: living room, kitchen, dining room, bedroom and bathroom. Off limit areas include: bedroom closet and balcony (unless supervised). There is no accessible garage. Business Hours are M-F 7:30am-5:30pm. An overall inspection of the facility was conducted. The inspection included, but was not limited to:

Physical Plant: The facility has a functioning carbon monoxide detector located in the bedroom and met statutory requirements. Fire extinguisher located in the laundry room, and smoke detector located in the living room meet State Fire Marshall standards. There were no open fireplaces or heaters. Storage areas for poisons, detergents, cleaning solutions, medications and other hazardous items are locked in a cupboard and inaccessible to children. Facility has a central pool in the condominium complex which is locked and gated. The applicant will use the park across the street for outdoor play with constant supervision if warranted. Applicant Grijalva advised there are no firearms or ammunition stored on the premises. The home is kept clean and orderly with heating and ventilation for safety and comfort. The home has no indoor stairs. The home provides safe toys, play equipment and materials.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 629-8413
LICENSING EVALUATOR NAME: Jennifer LottTELEPHONE: 619-782-8300
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2021
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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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: GRIJALVA, VANESSA FAMILY CHILD CARE
FACILITY NUMBER: 376100648
VISIT DATE: 03/03/2021
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LPA provided the applicant with the following: Child Care Advocates email address of childcareadvocatesprogram@dss.ca.gov.

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.

Additional Technical Assistance was provided and noted on the attached Technical Assistance Advisory Note.

No corrections are needed. A license for eight (8) children will be granted upon final file review.

An exit interview was conducted with Vanessa Grijalva. A copy of this report, Appeal and Licensee Rights (LIC 9058, Notice of Site Visit Form (LIC 9213) and Advisory Note (LIC 9102) have been provided via email. An email read receipt confirms the documents were received. Applicant also acknowledges that the LIC 9213 is required to be posted for 30 days.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 629-8413
LICENSING EVALUATOR NAME: Jennifer LottTELEPHONE: 619-782-8300
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2021
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: GRIJALVA, VANESSA FAMILY CHILD CARE
FACILITY NUMBER: 376100648
VISIT DATE: 03/03/2021
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Records Review: The new provider packet was reviewed with the applicant including information on children’s records, immunization, child abuse reporting, car seat laws, shaken baby syndrome, SIDS, safe sleep and the effects of lead poisoning. Also included was information on Incidental Medical Services and the YMCA Resource Center. Applicant stated they have sufficient financial resources to sustain the license. Applicant was reminded that any minor on their 18th birthday living in the home, new adults in the home or new staff must be cleared prior to living/working in the home.

Applicant was reminded that corporal punishment, smoking, walkers, exersaucers, jumpers and bouncy seats shall not be permitted during day care operation. All equipment that is used should be used only as intended by the manufacturer. Applicant Grijalva states they are aware that interference with a child’s daily functions, physical or mental abuse and corporal punishment is not permitted. Applicant has also been reminded that anything that states, “Keep out of reach of children” is to be inaccessible to children. LPA and applicant discussed California Megan’s Law and LPA provided the link www.meganslaw.ca.gov.

LPA discussed the following with the applicant: Maximum capacity for a small family child care home; 4 infants only (infants defined as children under 24 months) or 6 children with no more than 3 infants; or with landlord consent, 8 children with no more than 2 infants – 1 child in kindergarten or elementary school and 1 child at least age 6 including children under the age of 10 who reside in the applicant’s home.

Administration: All individuals subject to a criminal record review have obtained a clearance and/or an exemption prior working, residing or volunteering in the home. The applicant and other personnel have completed training on preventive health practices including pediatric CPR and First Aid. All staff have completed the mandated Child Abuse Reporting as per AB1207. Staff immunization were reviewed and are in compliance. There is a working telephone and email address.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 629-8413
LICENSING EVALUATOR NAME: Jennifer LottTELEPHONE: 619-782-8300
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2021
LIC809 (FAS) - (06/04)
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