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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376611715
Report Date: 07/15/2022
Date Signed: 07/15/2022 12:59:10 PM

Document Has Been Signed on 07/15/2022 12:59 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:FLOREZ, MAGNOLIA FAMILY CHILD CAREFACILITY NUMBER:
376611715
ADMINISTRATOR:MAGNOLIA FLOREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 505-9193
CITY:SAN DIEGOSTATE: CAZIP CODE:
92123
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
07/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Magnolia FlorezTIME COMPLETED:
01:15 PM
NARRATIVE
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On 7/15/22 at 8:55 AM, Licensing Program Analyst (LPA) Keturah Lane and co-worker Karen Chang (who shadowed the inspection) conducted an unannounced annual inspection with the Licensee. Upon arrival, LPA met with Licensee, Magnolia Florez 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, helpers Adriana Duque, Claudia Valencia Gomez and 10 daycare children (four under the age of 2 years). Proper supervision, ratios and capacity were observed. The fire extinguisher, carbon monoxide detector, and smoke detector meet requirements and are operational. At 9:45 AM, LPA observed hazardous items were accessible in garage that was not locked or latched. LPA also observed sharp knives & cutting utensils in an unlatched drawer in the kitchen, Clorox cleaner in an accessible bathroom cabinet (in master bedroom) and cosmetics/toiletries accessible in the master bedroom closet. Licensee removed items to an inaccessible place and stated she would install a latch to the garage door. Licensee stated that children are supervised in the home, even in the bathroom. 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 First Aid and CPR certifications expire on 5/2023. Helper’s First Aid and CPR certifications expire on 5/2023 & 5/2024. Licensee does not have proof of measles or flu immunizations. Staff do not have any proof of immunizations on file at facility. Licensee stated she would send proof to LPA via e-mail. Helpers did not have mandated reporter renewal certificates on file. Licensee maintains emergency records for children. Required documents are posted. LPA reviewed documentation of emergency drills and last (earthquake/fire) drill was conducted on 6/21/22. (continued on LIC809-C...)
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE: DATE: 07/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/15/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 9
Document Has Been Signed on 07/15/2022 12:59 PM - It Cannot Be Edited


Created By: Keturah Lane On 07/15/2022 at 11:31 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: FLOREZ, MAGNOLIA FAMILY CHILD CARE
FACILITY NUMBER: 376611715

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2022

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 LPA observed accessible hazards in garage, master bedroom and bathroom (see narrative in report) which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/18/2022
Plan of Correction
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Licensee removed all hazardous items from master bedroom and bathroom and stated she would install a latch to the garage by Monday, 7/18/22 to make garage inaccessible. Licensee stated she would send a picture of the latched garage door via e-mail to Keturah.Lane@dss.ca.gov by 7/18/22.
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: 07/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/15/2022 12:59 PM - It Cannot Be Edited


Created By: Keturah Lane On 07/15/2022 at 11:31 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: FLOREZ, MAGNOLIA FAMILY CHILD CARE
FACILITY NUMBER: 376611715

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record reivew, the licensee did not comply with the section cited above in 2 out of 2 helpers which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/29/2022
Plan of Correction
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Licensee stated she would have helpers complete the mandated training and send certificates via e-mail to Keturah.Lane@dss.ca.gov

website: www.mandatedreporterca.com (AB1207)
Type B
Section Cited
CCR
102416.1(a)(10)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information: (10) A signed and dated copy of the Notice of Employee Rights [LIC 9052, (Rev. 03/03)] as required by Section 102416(a) and Section 102417.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review the licensee did not comply with the section cited above in 2 out of 2 helpers which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/15/2022
Plan of Correction
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Licensee had staff members sign the LIC 9052 forms at time of inspection. LPA Lane kept copies for the file.
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: 07/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2022


LIC809 (FAS) - (06/04)
Page: 9 of 9
Document Has Been Signed on 07/15/2022 12:59 PM - It Cannot Be Edited


Created By: Keturah Lane On 07/15/2022 at 11:31 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: FLOREZ, MAGNOLIA FAMILY CHILD CARE
FACILITY NUMBER: 376611715

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 3 out of 3 staff records which poses a potential health, safety or personal rights risk to persons in care. Helpers do not have any immunization records on file. Licensee is missing measles and flu.
POC Due Date: 07/29/2022
Plan of Correction
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Licensee stated she would send proof of immunizations via e-mail to Keturah.Lane@dss.ca.gov by 7/29/22.
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: 07/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2022


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: FLOREZ, MAGNOLIA FAMILY CHILD CARE
FACILITY NUMBER: 376611715
VISIT DATE: 07/15/2022
NARRATIVE
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Licensee has provided adequate space for the children to eat, sleep and play within the home. Areas used for childcare include: living room, kitchen, dining area, den, baby nap room, bathroom, master bedroom which includes a smaller bathroom. Off limits areas include: bedroom which is inaccessible thorough the use of a door lock. Garage is off-limits but was accessible because door was not latched or locked. The fireplace is screened and Licensee stated she does not use the wall heater since she has solar heating & A/C. There is a working phone at the facility. The licensee has sufficient age appropriate, safe, toys and equipment available. The home has a large, fenced, fully paved backyard/patio available for outdoor activities. Some shade is provided via small sails. Licensee stated she will be installing additional shade for the backyard later this year.

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: 07/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2022
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: FLOREZ, MAGNOLIA FAMILY CHILD CARE
FACILITY NUMBER: 376611715
VISIT DATE: 07/15/2022
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 Magnolia Florez that this report dated 7/15/22 document(s) 1 Type A citation which shall be posted for 30 consecutive days as there is an immediate risk(s) to the health, safety, or personal rights of children in care. Type B deficiencies were also cited.

Also, LPA Keturah Lane informed the licensee Magnolia Florez to provide a copy of this licensing report dated 7/15/22 that documents any Type A citation(s) 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, Magnolia Florez. 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: 07/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2022
LIC809 (FAS) - (06/04)
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