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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376604029
Report Date: 03/17/2023
Date Signed: 03/17/2023 04:27:24 PM

Document Has Been Signed on 03/17/2023 04:27 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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:GUZMAN, ELSA FAMILY CHILD CAREFACILITY NUMBER:
376604029
ADMINISTRATOR:ELSA GUZMANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 560-1869
CITY:SAN DIEGOSTATE: CAZIP CODE:
92123
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
03/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Elsa GuzmanTIME COMPLETED:
04:40 PM
NARRATIVE
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On 3/17/23 at 1:10 PM, Licensing Program Analyst (LPA) Keturah Lane conducted an unannounced annual inspection with the Licensee. Upon arrival, LPA met with Licensee, Elsa Guzman and provided the Inspection Checklist (LIC126). The one-story home was toured and inspected to ensure an environment safe for the care and supervision of children. Present were the Licensee, Licensee’s helper Elizabeth Guzman and four daycare children. Proper supervision, ratios and capacity were observed. The fire extinguisher, carbon monoxide detector, and smoke detector meet requirements and are operational. At 1:20 PM, LPA observed in the kitchen an aerosol cleaner accessible below sink and sharp knives in an unlatched drawer. In the bathroom, LPA observed shampoos and toiletries accessible in the bathtub & under the sink in unlatched cabinet. The three off-limit bedrooms were not locked and were accessible. Garage was also accessible as the door was not locked. Licensee stated the children do not go in the off-limit areas. LPA advised that off-limit areas must be inaccessible during day care hours and advised door-knob covers in case anyone forgets to lock the doors. Licensee removed the sharp knives and cleaners and put them high out of reach. There are no bodies of water on the property. Licensee states that there are no weapons in the home. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. 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.
Licensee’s & Helpers First Aid and CPR certifications expire on 5/2023. Licensee and staff meet immunization requirements and have completed Mandated Reporter Training which expires 10/30/24 (Helpers expire 9/12/23). Licensee maintains emergency records for children. (continued on LIC809-C...)
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE: DATE: 03/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/17/2023
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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Document Has Been Signed on 03/17/2023 04:27 PM - It Cannot Be Edited


Created By: Keturah Lane On 03/17/2023 at 02:22 PM
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: GUZMAN, ELSA FAMILY CHILD CARE
FACILITY NUMBER: 376604029

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/17/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, the licensee did not comply with the section cited above as off-limit areas were accessible (containing cleaners, toiletries and other hazards) which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/20/2023
Plan of Correction
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Licensee stated she would install door knob cover on the garage and keep the bedroom doors locked during daycare hours. Licensee stated she would sign a written statement regarding the doors being locked. Licensee stated she would send a picture of the bathroom (bath and cabinet) with shampoos/toiletries removed and video of doors locked. Send pictures and video to: Keturah.Lane@dss.ca.gov
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Monica Cuddy
LICENSING EVALUATOR NAME:Keturah Lane
LICENSING EVALUATOR SIGNATURE:
DATE: 03/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/17/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/17/2023 04:27 PM - It Cannot Be Edited


Created By: Keturah Lane On 03/17/2023 at 02:22 PM
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: GUZMAN, ELSA FAMILY CHILD CARE
FACILITY NUMBER: 376604029

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/17/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview with Licensee and record review, the licensee did not comply with the section cited above as she had no fire drill log which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/07/2023
Plan of Correction
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Licensee stated she would conduct a fire drill prior to 4/7/23 with the children and document it on the emergency drill log. Licensee will e-mail the log to LPA at: Keturah.Lane@dss.ca.gov
Type B
Section Cited
CCR
102425(j)(2)(D)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and Licensee interview, the licensee did not comply with the section cited above in 2 out of 8 children which poses a potential health, safety or personal rights risk to persons in care. (safe sleep log - document every 15 minutes when children are sleeping).
POC Due Date: 04/07/2023
Plan of Correction
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Licensee stated she would document the 15 minute checks on a safe sleep log for the two children in care that are under 2 years of during the week of 3/20 - 3/24 (2023). Licensee will e-mail the sleep logs to LPA at: Keturah.Lane@dss.ca.gov
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:Monica Cuddy
LICENSING EVALUATOR NAME:Keturah Lane
LICENSING EVALUATOR SIGNATURE:
DATE: 03/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/17/2023


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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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: GUZMAN, ELSA FAMILY CHILD CARE
FACILITY NUMBER: 376604029
VISIT DATE: 03/17/2023
NARRATIVE
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During record review, Licensee was not aware of the requirement to document 15-minute checks when children under two years of age are sleeping. There was one child present under 2 years of age. Licensee was also not aware of the Individual Sleeping Plan (LIC9227) form required for children under 12 months of age. LPA provided technical assistance with the forms. Required documents are posted. Licensee does not conduct emergency drills or document them. LPA provided technical assistance regarding emergency drills and provided the drill log for Licensee.

Licensee has provided adequate space for the children to eat, sleep and play within the home. Areas used for childcare include: living room, kitchen, family room #1, family room #2 and bathroom. Off limits areas include: garage, master bedroom which includes a smaller bathroom, bedroom #2 and bedroom #3. The garage and bedrooms were accessible as the doors were not covered or locked. The fireplace is screened. There is a working phone at the facility. The licensee has sufficient age appropriate, safe, toys and equipment available. The home has a fully fenced backyard available for outdoor activities. Licensee owns the home.

Provider is hereby reminded of the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, 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 and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov. LPA Lane reviewed Covid-19 guidelines with Licensee and provided Covid-19 resources. LPA Lane directed Licensee to website: https://www.cdss.ca.gov/inforesources/community-care-licensing to receive important updates and information.
LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at:https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee 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. (continued on LIC809-C...)
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2023
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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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: GUZMAN, ELSA FAMILY CHILD CARE
FACILITY NUMBER: 376604029
VISIT DATE: 03/17/2023
NARRATIVE
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Incidental Medical services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

LPA Keturah Lane informed licensee Elsa Guzman that this report dated 3/17/23 documents 1 Type A citation (and 2 Type B citations) which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA informed the licensee to provide a copy of this licensing report dated 3/17/23 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with the licensee, Elsa Guzman. 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.



To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2023
LIC809 (FAS) - (06/04)
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