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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376300206
Report Date: 11/03/2021
Date Signed: 11/03/2021 10:55:51 AM

Document Has Been Signed on 11/03/2021 10:55 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
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:LITTLE ELMSFACILITY NUMBER:
376300206
ADMINISTRATOR:GALEANA-GODINEZ, OSCARFACILITY TYPE:
850
ADDRESS:117 N ELM STTELEPHONE:
(424) 257-2857
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY: 23TOTAL ENROLLED CHILDREN: 23CENSUS: 0DATE:
11/03/2021
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:03 AM
MET WITH:Licensee Jocelyn TelloTIME COMPLETED:
11:04 AM
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An informal meeting was held in the Riverside Child Care Regional Office on 11/3/21. Present in the conference/meeting were Licensee, Jocelyn Tello, Licensing Program Manager (LPM) Pauline Beschorner and Licensing Program Analyst (LPA) Otsanya Cameron

During the conference, the facility’s most recent issues/violations were discussed:

Staff Records- Clearances, Civil Penalty, Immunization records, Mandated reporter training certificates, updated Administration records, Designation of Responsibility, Reporting responsibilities and Technical Support Program (TSP)

The licensee disclosed the following measures were taken: For the Type A violation issued resulting in a civil penalty, a background Clearance was obtained for Staff previously uncleared. Additional staff who was cleared but not associated have been transferred to the facility with assistance from licensing staff.

The licensee provided a Director’s packet to list herself as the director. It was discussed with the licensee the requirement of the site Director and the expectation to have a Plan B in place.

The Type B deficiencies cited on 10/18 that were supposed to be cleared by Plan of Correction date of 10/28/21 has been granted an extension per LPM Beschorner through COB 11/8/21.

Continued on LIC809-C

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Otsanya Cameron
LICENSING EVALUATOR SIGNATURE: DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/03/2021
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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: LITTLE ELMS
FACILITY NUMBER: 376300206
VISIT DATE: 11/03/2021
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LPM Beschorner discussed the option to have the state licensing department assist by referring this facility to participate in the Technical Support Program (TSP). The Licensee Joselyn Tello, stated that she would be happy to participate to get her facility and staff back on the right track to serving children.

In addition, the following resources/information was provided:

· Resources that include Quarterly Updates, Self-Assessment Guides, Training videos regarding various sections of Title 22 are online at www.cdss.ca.gov/inforesources/Community-Care-Licensing.

· The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at:


1-844-LET-US-NO (1-844-538-8766) and/or 951-782-4200.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Otsanya Cameron
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021
LIC809 (FAS) - (06/04)
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