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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376611084
Report Date: 10/02/2024
Date Signed: 10/02/2024 03:52:44 PM

Document Has Been Signed on 10/02/2024 03:52 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:FLORES, HERMILA FAMILY CHILD CAREFACILITY NUMBER:
376611084
ADMINISTRATOR/
DIRECTOR:		FLORES, HERMILAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 482-5661
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
10/02/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Hermila Flores, ProviderTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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On October 2, 2024, at 1:45 a.m., Licensing Program Analyst (LPA), D. Sanchez, conducted an unannounced Annual Random Inspection and met with the Licensee, Hermila Flores. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. Three (3) children, provider and one (1) staff were present in the facility during this inspection. This facility is a two story, three bedroom, two bathroom house. Licensee accompanied LPA inside and out of the facility during this inspection. The following areas used for child care are: Living room, dining room, kitchen, bathroom, both side yards and half of backyard. Off limits areas are: 2nd floor, the back half of the backyard and are inaccessible through use of door knob protection and gate.

The fire extinguisher, smoke detector, and carbon monoxide detector met requirements. All hazardous items were inaccessible to children. The storage area for poisons is locked. The licensee has toys, play equipment and materials available. The home has a fenced backyard available for outdoor activities. There is a pool in the backyard that has been properly barricaded according to departments regulations. Licensee stated 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. There is an adult resident living in a mobile home parked in the second half of the off limits backyard. Adult resident is not fingerprint clear. Licensee’s First Aid and CPR certifications expire on 07/2026. Licensee has required immunizations. Licensee completed Mandated Reporter Training on 6/2023. Facility roster is maintained and was reviewed. The last fire and disaster drills were conducted and documented on 7/2024.

There is one crib or play yard for each infant who is unable to climb out of the crib or play yard. Cribs or play yards are free from all loose articles and objects. The provider physically checks on sleeping infants every 15 minutes. An Individual Infant Sleeping Plan [LIC 9227 (3/20)] is maintained for each infant up to 12 months of age. The provider places infants up to 12 months of age on their backs for sleeping.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Diana Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2024
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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: FLORES, HERMILA FAMILY CHILD CARE
FACILITY NUMBER: 376611084
VISIT DATE: 10/02/2024
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LPA provided and discussed the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, and ensure that all adults residing or working in the home have criminal background clearances or exemptions. Licensee was reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers and/or similar equipment are not allowed in daycare. Licensee was also provided handouts with information regarding upcoming Safe Sleep Regulations/SIDS, Lead exposure and Shaken Baby Syndrome. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

LPA discussed and provided Licensee with the following: child care advocates email address: childcareadvocatesprogram@dss.ca.gov . In addition, for general questions or questions regarding licensing requirements contact the Child Care Licensing Duty Line at (619) 767-2248.

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.

California Code of Regulations, (Title 22, Division 12 & Chapter 3), are being cited on the attached LIC 809-D.

Upon Receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

An exit interview was conducted with the licensee. The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.

LPA provided notice of site visit and observed it being posted at the facility.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Diana Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024
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Document Has Been Signed on 10/02/2024 03:52 PM - It Cannot Be Edited


Created By: Diana Sanchez On 10/02/2024 at 03:24 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: FLORES, HERMILA FAMILY CHILD CARE
FACILITY NUMBER: 376611084

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/02/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in allowing an uncleared adult reside in a motorhome parked in the off limits backyard which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/03/2024
Plan of Correction
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Provider Hermila Flores, stated that she will ensure to remove adult residen from the motorhome effective today and will ensure to get him fingerprinted. Hermila will send a written statement to the San Diego Child Care Regional Office (SDCCR) advising her plan to ensure unclear person is removed from premises.
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:Jason Garay
LICENSING EVALUATOR NAME:Diana Sanchez
LICENSING EVALUATOR SIGNATURE:
DATE: 10/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/02/2024


LIC809 (FAS) - (06/04)
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