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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101175
Report Date: 03/27/2024
Date Signed: 03/29/2024 11:00:17 AM

Document Has Been Signed on 03/29/2024 11:00 AM - 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 NORTH, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:WEN, MIAOXIN & JESSE FAMILY CHILD CAREFACILITY NUMBER:
376101175
ADMINISTRATOR:MIAOXIN & JESSE WENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(442) 237-7707
CITY:SAN DIEGOSTATE: CAZIP CODE:
92128
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 7DATE:
03/27/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Miaoxin and Jesse WenTIME COMPLETED:
04:45 PM
NARRATIVE
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THIS IS AN AMENDED COPY OF AN ORIGINAL REPORT DELIVERED ON 3/29/24.

On March 27, 2024 at 1:35 PM., Licensing Program Analyst (LPA) Sherlynn Banas conducted an unannounced case management inspection. Licensee was met with Jesse Wen. Miaoxin was at school and later came at 3:00 PM. Licensee was home with 7 day care children. Licensees stated that there were 10 enrolled children.

Upon arrival, LPA observed 2 children napping and the rest were doing activities with staff #1 who was cleared but not associated to the facility.

See LIC809D for Type B deficiency cited today.

Type B deficiencies if not corrected poses a potential risk to the health, safety and personal rights of children in care.

Exit interview conducted and report was reviewed with the licensee, Miaoxin Wen and Jesse Wen.

A notice of site visit was given to licensee and must remain posted for 30 days.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Sherlynn Banas
LICENSING EVALUATOR SIGNATURE: DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/27/2024
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 03/29/2024 11:52 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 03/28/2024 08:51 AM


Created By: Sherlynn Banas On 03/27/2024 at 04:19 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO NORTH, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: WEN, MIAOXIN & JESSE FAMILY CHILD CARE
FACILITY NUMBER: 376101175

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/27/2024
Section Cited
CCR
102370(d)(2)

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THIS IS AN AMENDED VERSION OF AN ORIGINAL REPORT.Criminal Record Clearance. All individuals subject to a criminal record review... shall prior to working...in a licensed facility...Request a transfer of a criminal record clearance ...This requirement was not met as evidenced by:
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Licensee, Jesee and Miaoxin Wen states they submitted the transfer request through mail. Licensees could not provide proof of submission and CCL has no record of receiving. Licensee provided a transfer request form to be processed
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Based o interviews and record review, Licensee did not associate staff#1 to the facility who has been working in the facility since February 2024 which poses a potential health and safety risk to children in care.This is a repeat violation civil penalty assessed.
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Licensee states that in the future they will email transfer request to SDIncidentReports@dss.ca.gov to ensure receipt or register and complete through Guardian. Licensees will ensure to verify clearances associated prior to first day in 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 Daniel
LICENSING EVALUATOR NAME:Sherlynn Banas
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2024


LIC809 (FAS) - (06/04)
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