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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376616408
Report Date: 06/20/2024
Date Signed: 06/20/2024 10:21:51 AM

Document Has Been Signed on 06/20/2024 10:21 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:JOHNSON-SCHIRLLS, TAMIE & SCHIRLLS, AMBER FCCFACILITY NUMBER:
376616408
ADMINISTRATOR/
DIRECTOR:		TAMIE J. & AMBER S.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 444-1456
CITY:EL CAJONSTATE: CAZIP CODE:
92020
CAPACITY: 14TOTAL ENROLLED CHILDREN: 13CENSUS: 9DATE:
06/20/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:58 AM
MET WITH:Amber Johnson SchrillsTIME VISIT/
INSPECTION COMPLETED:
10:15 AM
NARRATIVE
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On 6/20/24 at 8:58 a.m., Licensing Program Analyst (LPA) Renita Rodriguez and LPA Nancy Diaz conducted an unannounced inspection with the Licensee. Upon arrival, LPAs identified themselves. LPA met with Licensee, Amber Schirlls. The home was toured and inspected to ensure an environment safe for the care and supervision of children. Present in the home at time of arrival was Amber Schirlls, Michael Schirlls, Travis Johnson and Lanore Johnson.

At the time of arrival (8:05 a.m), 6 children in care were present. 2 more children in care arrived at 8:25 am. 9th children arrived at 8:30. Licensee, Tamie Schirlls arrived at 8:30 a.m.

A review of children's records was conducted and Type B deficiency was cited. Type B deficiency if not corrected poses a potential risk to the health safety and personal rights to children in care.

Exit interview conducted and report was reviewed with the licensee, Tamie Schirlls.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Renita Rodriguez
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2024
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 06/20/2024 10:21 AM - It Cannot Be Edited


Created By: Renita Rodriguez On 06/20/2024 at 09:32 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: JOHNSON-SCHIRLLS, TAMIE & SCHIRLLS, AMBER FCC
FACILITY NUMBER: 376616408

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/27/2024
Section Cited
CCR
102425(2)(D)(c)

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INFANT SAFE SLEEP D) Documentation shall be maintained in the infant’s file,,, Time of each 15-minute check. This requirement is not met as evidenced by:

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Licensee states will maintain the sleep logs. Licensee will review the provider information notice. The logs will be placed with a pen in an area that is easily accessible for the logs to be maintained. Licensee will submit the nap logs to the department by 6/272/4.
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Based on observaton, interview, and record review, the licensee did not maintain the 15 minute nap checks which poses a Potential Health, Safety or Personal Rights risks to persons 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:Renesha Askew
LICENSING EVALUATOR NAME:Renita Rodriguez
LICENSING EVALUATOR SIGNATURE:
DATE: 06/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/20/2024


LIC809 (FAS) - (06/04)
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