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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376601494
Report Date: 09/19/2024
Date Signed: 09/19/2024 01:55:39 PM

Document Has Been Signed on 09/19/2024 01:55 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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:RUIZ, ANA LAURA FAMILY CHILD CAREFACILITY NUMBER:
376601494
ADMINISTRATOR/
DIRECTOR:		RUIZ, ANA LAURAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 690-0480
CITY:SAN DIEGOSTATE: CAZIP CODE:
92154
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
09/19/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Licensee Ana Laura RuizTIME VISIT/
INSPECTION COMPLETED:
02:25 PM
NARRATIVE
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On 09/19/2024 at 10:45 am, Licensing Program Analysts (LPAs) Michelle Hood and Shannan Williams conducted an unannounced inspection. During initial 10-day inspection on 09/19/2024, the LPAs observed the licensees helper caring for an infant (one and an half years old) at the facility.

During the interview with the licensee and a review of the facility associations, it was determined the helper is fingerprint cleared; however, she is not associated to the facility. During an interview, the licensee admitted the parent of the infant in care at the facility during today's inspection did not complete the Identification and Emergency Information Child Care Centers/Family Child Homes- LIC 700 form. Also while the LPAs conducted a children's file review, the LIC 700 was missing for five other children. The licensee disclosed she does not check or document on sleeping infants every 15 minutes.

An exit interview was conducted, and the report was reviewed with the licensee Ana Laura Ruiz. The licensee was provided with a copy of their appeal rights (LIC 9058 03/22) and their signature on this form acknowledges receipt of these rights. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. See LIC 809D for deficiencies cited.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Michelle Hood
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2024
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 09/19/2024 01:55 PM - It Cannot Be Edited


Created By: Michelle Hood On 09/19/2024 at 11:20 AM
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: RUIZ, ANA LAURA FAMILY CHILD CARE
FACILITY NUMBER: 376601494

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/20/2024
Section Cited
CCR
102370(d)(2)

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102370 (d)(2)Criminal Record Clearance. All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: Request a transfer of a criminal record clearance as specified in Section 102370(j)...This requirement was not met by:
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During the inspection the licensee completed the Criminal Background Clearance Transfer Request- LIC 9182. The licensee wrote a declaration stating she understands anyone who works, resides or volunteers must be fingerprint cleared and associated before initial presence in the facility.
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Based on record review and the licensees admittance the licensee did not associate the helper before initial presence in the facility. This is a potential health and safety risk to children in care.
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Type B
09/27/2024
Section Cited
CCR102417(g)(7)

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102417(g)(7)Operation of a Family Child Care Home. An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent...to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee... to consent to emergency medical care. This requirement was not met by...
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The licensee stated she will provide the LIC 700 to the parents and request the form be returned on the next day of care. The licensee will provide to the LPA a copy no later than 09/27/2024.
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Based on the licensees admittance and a file review there was six out of six children's Identification and Emergency Information Child Care Centers/Family Child Homes- LIC 700 form was missing from the files. This is a potential health and safety risk to children 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:Cynthia Gray
LICENSING EVALUATOR NAME:Michelle Hood
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/09/2024 11:18 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 11/22/2024 03:36 PM


Created By: Shannan Williams On 09/19/2024 at 11:58 AM
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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: RUIZ, ANA LAURA FAMILY CHILD CARE
FACILITY NUMBER: 376601494

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/27/2024
Section Cited
CCR
102425(j)(1)

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102425(j)(1) Infant Safe SleepThe provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes. The provider shall check and document the following: This is requirement is not met by:
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During the inspection the licensee wrote a declaration stating she understands she must check and document every 15 mins. when infants are napping while in her care.
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Based on the licensees admittance and record review, the licensee has not been checking and documenting on the infants every 15 mins. This is a potential health and safety risk for children 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:Cynthia Biszant
LICENSING EVALUATOR NAME:Shannan Williams
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2024


LIC809 (FAS) - (06/04)
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