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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376101958
Report Date: 07/30/2024
Date Signed: 07/30/2024 03:00:01 PM

Document Has Been Signed on 07/30/2024 03:00 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 N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:ETIENNE, GUERLINE FAMILY CHILD CAREFACILITY NUMBER:
376101958
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
07/30/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Guerline and Manissarde EtienneTIME VISIT/
INSPECTION COMPLETED:
03:05 PM
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An office meeting was held in the San Diego North Child Care Office. Present during this office meeting were Licensing Program Manager, Renesha Askew, Licensing Program Analyst, Victoria Hernandez, and Applicants, Guerline and spouse Manissarde Etienne. Meeting was translated in Haitian Creole, via telephone by Focus Language International, Inc., (Operator #83995227) The purpose of this meeting was to discuss the pending application received on 3/11/2024 and corrections needed to make application complete as well as Mr. Manissarde Etienne’s demeanor and interactions during his recent visits to the Regional Office.

Updated application form, LIC 279, was received on 07/19/2024 which changed the request from a small license to a large, and added a co-licensee, Mr. Etienne. Applicant states she does not want her spouse as co-licensee and would provide an updated application. Department advised that there was an error when application was processed at receipt. Her application will be corrected to reflect her request for a large license. Was advised of the difference in fee of $34 that will be needed as she was originally charged $36 instead of the $70 required. Applicants state their understanding of the need to be patient during this process.

Also, during this meeting LPM discussed Mr. Etienne’s inappropriate conduct during his office visits on 7/22/24 & 7/26/24 and the need for all of us to foster a good working relationship with each other at all times by ensuring a professional tone and demeanor by Applicants, Residents, as well as the Department. Applicant apologized for spouse behavior and spouse took responsibility for his actions.

Licensee was also provided with the CDSS Child Care Licensing (CCL) Family Child Care Providers Resource link with instructional videos: https://ccld.childcarevideos.org/family-child-care-providers/. It is recommended for Applicants to review the videos including, but not limited to: “Is Family Child Care the Right Business for Me?”, “Background Check Requirements for Caregivers”, “Your Rights as a Child Care Licensee”, “How to Apply for a Family Child Care License”, and “Community Care Licensing Inspection Authority”.

(continued on LIC809C page 2)

SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Victoria Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/30/2024
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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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: ETIENNE, GUERLINE FAMILY CHILD CARE
FACILITY NUMBER: 376101958
VISIT DATE: 07/30/2024
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Applicants states their understanding of the above as well as their need to abide by Health and Safety Code and Title 22 Regulations in the operation of a Family Child Care Home if licensed.

Licensee was advised to regularly visit the Community Care Licensing WEB SITE: www.ccld.ca.gov for quarterly updates and regulation. RO Recommended Applicants sign up to receive the Provider Information Notices (PINs) and provided registration link: https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe.During meeting licensee was provided the Duty Line: 619-767-2248 who is available to assist Monday – Friday 8am-5pm.


Exit interview conducted and report was reviewed and provided to Applicants, Guerline and Manissarde
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Victoria Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024
LIC809 (FAS) - (06/04)
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