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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101528
Report Date: 07/03/2024
Date Signed: 09/04/2024 04:10:26 PM

Document Has Been Signed on 09/04/2024 04:10 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 NORTH, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:ESPINOSA, LEONIE FAMILY CHILD CAREFACILITY NUMBER:
376101528
ADMINISTRATOR/
DIRECTOR:		LEONIE ESPINOSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 435-9372
CITY:CARLSBADSTATE: CAZIP CODE:
92009
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
07/03/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:00 PM
MET WITH:Leonie EspinosaTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
NARRATIVE
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On 7/03/24 at 4:00 PM Licensing Program Analyst (LPA) Sherlynn Banas conducted an unannounced Case Management Deficiency visit for the purpose of issuing a deficiency discovered during the 10-day visit on June 12, 2024, investigation. Upon LPA Banas investigation on files and health requirements such as CPR/First Aid, Licensee, Leonie Espinosa's CPR/FA expired in May 2024. Licensee has a scheduled CPR/FA training on June 10, 2024. Licensee submitted her current CPR/FA certificate on June 18, 2024 to LPA Banas.

Deficiency cited on LIC 809 D

Exit interview conducted and report was reviewed with the Licensee, Leonie Espinosa. Appeal rights and notice of site visit was given and must remain posted for 30 days.


SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Sherlynn Banas
LICENSING EVALUATOR SIGNATURE: DATE: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/03/2024
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 09/04/2024 04:10 PM - It Cannot Be Edited


Created By: Sherlynn Banas On 07/03/2024 at 05:04 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
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: ESPINOSA, LEONIE FAMILY CHILD CARE
FACILITY NUMBER: 376101528

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/03/2024
Section Cited
CCR
102416(c)

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The licensee and other personnel as ...shall complete training on preventative health practices, including...and pedriatric first aid, pursuant to Health and Safety Code Section 1596.866
This requirement is not met as evidenced by:
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Licensee, Leonie Espinosa took the CPR/FA training on June 18, 2024. She submitted the certifate to LPA Banas on June 18, 2024 theough email.
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Baed on record review, the licensee did not comply with section cited above as CPR/FA certificate expired May 2024 and was not renewed which poses a potential health, safety or personal rights risk to persons 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:Tashima Daniel
LICENSING EVALUATOR NAME:Sherlynn Banas
LICENSING EVALUATOR SIGNATURE:
DATE: 07/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/03/2024


LIC809 (FAS) - (06/04)
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