376101715-12-12-2023-51-CC-GPOR-CYFPYD-20231212104346

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376101715
Report Date: 12/12/2023
Date Signed: 12/12/2023 10:43:51 AM

Document Has Been Signed on 12/12/2023 10:43 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 N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	DOMINGUEZ LOPEZ, DANIELA FAMILY CHILD CARE		FACILITY NUMBER:	376101715
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 8	DATE:	12/12/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Daniela Dominguez Lopez		TIME COMPLETED:	11:00 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 12/12/23 at 9:15 am, Licensing Program Analyst (LPA) Gerald Poindexter conducted an unannounced inspection for an Increase in Capacity application. LPA met with licensee Daniela Dominguez Lopez. Licensee submitted application to the Department on 11/3/23. Fire clearance report was provided to the Department on 11/15/23. The three-bedroom, two-bath, one-story home was toured and inspected to ensure an environment safe for the care and supervision of children. Present in the home were 8 children, one of whom were under 24 months, and one of whom was the the licensee’s child. The following areas will be used for child care: living room, dining room, bedroom 1, bathroom inside bedroom 1, and front yard. Off limit areas are kitchen, bedrooms 2 and 3, back bathroom, side and backyard and are inaccessible by use of gate at the kitchen making the back part of the home, side and back yard inaccessible. The licensee has sufficient toys and equipment available. The home has a fenced/gated front yard patio area available for outdoor activities. Licensee understands that supervision is required at all times during outdoor activities. The fire extinguisher, smoke detector, and carbon monoxide detector meet requirements and are operational. All hazardous items were secured out of reach of children via safety gate and high placement. There is no body of water on the property. Licensee states that there are no weapons in the home. Pediatric First Aid and CPR certifications for licensee expire on 10/2025. LPA advised licensee of all helper/aide requirements. Licensee has required immunizations. Licensee completed Mandated Reporter Training on 12/12/23 and was reminded it must be completed every 2 years. LPA observed all required postings were posted. Children’s records were reviewed and found to be in order. Staff records were reviewed. Licensee maintains a current roster of the children which LPA obtained during time of inspection. CONTINUED ON PAGE 2

SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Gerald Poindexter
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: DOMINGUEZ LOPEZ, DANIELA FAMILY CHILD CARE	FACILITY NUMBER: 376101715
	VISIT DATE: 12/12/2023

NARRATIVE

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Licensee moved into the residence with the past two months and LPA reminded her that emergency drills must be conducted and documented every six months. LPA verified that all adults living or working in the home have been fingerprint cleared and associated. LPA reminded Licensee that all unusual incident reports shall be submitted to Licensing office via email at SDIncidentReports@dss.ca.gov or via fax at (619)767-2203. Duty officer number is (619)767-2248.

Provider is hereby reminded of the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms; corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer.

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource. LPA also informed applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/, and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Licensee was reminded that all adults 18 and over living or working in the home, 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.

The Licensee rents the home and provided proof of control of property. Capacity limitations were reviewed. Licensee is to be present in the home to ensure children are supervised and is reminded that the license is NOT transferable and should she relocate, this license will be null and void.

No corrections are needed. A license for 14 children may be issued upon final file review. Licensee was reminded that annual fees are due on the date they were licensee every year.

CONTINUED ON PAGE 3

SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Gerald Poindexter
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: DOMINGUEZ LOPEZ, DANIELA FAMILY CHILD CARE	FACILITY NUMBER: 376101715
	VISIT DATE: 12/12/2023

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	Exit interview conducted and report was reviewed with the licensee Daniela Dominguez Lopez. During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Gerald Poindexter
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

LIC809 (FAS) - (06/04)

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