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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376603119
Report Date: 03/21/2024
Date Signed: 03/21/2024 01:15:06 PM

Document Has Been Signed on 03/21/2024 01:15 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:BUGIELSKI, MARYGRACE FAMILY DAY CAREFACILITY NUMBER:
376603119
ADMINISTRATOR:BUGIELSKI, MARYGRACEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 945-2221
CITY:OCEANSIDESTATE: CAZIP CODE:
92056
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 10DATE:
03/21/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:MaryGrace BugielskiTIME COMPLETED:
01:30 PM
NARRATIVE
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On date and time above, Licensing Program Analyst (LPA) Keely Messerschmidt made an unannounced case management visit due to licensee being in operation while on inactive status.

On Monday February 26th 2024, Licensee MaryGrace Bugielski requested to extend her inactive status to August 26th 2024. It was brought to Community Care Licensing (CCL) attention that Licensee has been in operation during this time. See LIC-809D for cited deficiency.

LPA observed 2 infants and 6 preschool aged children sleeping in pack in plays. Also present were Licensee's 2 infant grandchildren.

An exit interview was conducted, Notice of Site Visit posted and a copy of this report was provided. Appeal Rights were discussed and provided.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Keely Messerschmidt
LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2024
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 03/21/2024 01:15 PM - It Cannot Be Edited


Created By: Keely Messerschmidt On 03/21/2024 at 11:55 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
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: BUGIELSKI, MARYGRACE FAMILY DAY CARE
FACILITY NUMBER: 376603119

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/21/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/21/2024
Section Cited
CCR
1596.8535(d)

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Time for inspection or site visit or child daycare facility; department regulations for notification of period of inactivity; inactive status of licensees: (d) However, if the department believes the licensee is operating during a period in which the department has granted inactive status to the licensee,
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Licensee agrees to seize operation immediately until she updates Community Care Licensing on reopening her facility and an annual inspection is completed.
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 the department may enter the facility for any inspection permitted by law.
This was not met as evidenced by, a complaint was received pertaining to a Personal Rights violation while Licensee is on inactive status. This is a potential risk to the health and safety of 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:Deborah Mullen
LICENSING EVALUATOR NAME:Keely Messerschmidt
LICENSING EVALUATOR SIGNATURE:
DATE: 03/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/21/2024


LIC809 (FAS) - (06/04)
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