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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376614765
Report Date: 02/24/2023
Date Signed: 02/24/2023 11:54:48 AM

Document Has Been Signed on 02/24/2023 11:54 AM - 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:MATA, RAQUEL FAMILY CHILD CAREFACILITY NUMBER:
376614765
ADMINISTRATOR:RAQUEL MATAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 690-9538
CITY:SAN DIEGOSTATE: CAZIP CODE:
92154
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 1DATE:
02/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Raquel MataTIME COMPLETED:
12:00 PM
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On February 24, 2023 at 10:15 a.m., Licensing Program Analyst (LPA), Edgar Campana conducted an unannounced Annual Required Inspection and met with the Licensee, Raquel Mata.  LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. One daycare child and one cleared adult were present in the facility during this inspection. This facility is a one story, 3 bedroom, 3 bathroom house. Licensee accompanied LPA inside and outside of the facility during this inspection. Daycare areas includes: living room, family room, dining room, backyard, kitchen, hallway bathroom, and bathroom located at back of house. Off limits areas includes: all living rooms and garage. It should be noted that licensee stated that she wishes to make her master bedroom off limits. LPA advised for Licensee to submit an updated LIC279A and LIC999A to the San Diego Regional Office.

The fire extinguisher, type 3-A:40-B:C is operational and is located in the kitchen. The smoke detector and carbon monoxide detectors met requirements.  All hazardous items were inaccessible to children. The licensee has toys, play equipment and materials available. Licensee’s First Aid and CPR certifications expire on 05/2024.  Licensee has required immunizations.  Mandated Reporter Training certificate expires on 03/2024. Facility roster is maintained and was reviewed. The last fire and disaster drills were conducted and documented on 01/2023. Licensee stated that there are no firearms in the home.

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.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Edgar Campana
LICENSING EVALUATOR SIGNATURE: DATE: 02/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/24/2023
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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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: MATA, RAQUEL FAMILY CHILD CARE
FACILITY NUMBER: 376614765
VISIT DATE: 02/24/2023
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Licensee was also given information regarding 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. 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.

No deficiencies cited during today's visit.

Exit interview conducted and report was reviewed with the licensee, Raquel Mata in Spanish. The following was provided to licensee: LIC809, Appeal Rights, and Notice of Site Visit. Licensee was advised that Notice of Site Visit must be posted for 30 days from today's visit.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Edgar Campana
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2023
LIC809 (FAS) - (06/04)
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