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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376616522
Report Date: 03/06/2024
Date Signed: 03/06/2024 03:12:17 PM

Document Has Been Signed on 03/06/2024 03:12 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
SAN DIEGO NORTH, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:CHRISTENSEN, THERESA & JAROD FAMILY CHILD CAREFACILITY NUMBER:
376616522
ADMINISTRATOR:THERESA & JAROD C.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 334-0797
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 8DATE:
03/06/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Jarod ChristensenTIME COMPLETED:
03:35 PM
NARRATIVE
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On March 6, 2024, Licensing Program Analyst (LPA) Sherlynn Banas conducted and unannounced visit for a complaint. LPA banas was met by Jarod Christensen (licensee). There were 8 children present and they were in ratio. While recorded were being asked for the infant, there was no record of Individual Sleeping Plan. A sleep log for the infant is available.

Deficiency was cited (Included in 809 D)

Exit interview and report was conducted with licensee, Jarod Christensen. Appeal Rights and Notice of Site Visit was provided.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Sherlynn Banas
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2024
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 2
Document Has Been Signed on 03/06/2024 03:12 PM - It Cannot Be Edited


Created By: Sherlynn Banas On 03/06/2024 at 02:57 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: CHRISTENSEN, THERESA & JAROD FAMILY CHILD CARE
FACILITY NUMBER: 376616522

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/06/2024
Section Cited
HSC
10245(c)(2)

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(c) An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 month of age the provider has in care and maintained at the facility in the infant’s file.
(1) This plan shall be signed and dated by the infant’s authorized representative.

(2) The Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be maintained in the infant’s file and shall be available to the Department for review.
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Mr. Jarod Christensen will email the Individual Sleep Plan for an infant in care within 5 days and to be emailed to LPA Banas.
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As evidenced by not having an Individual Sleep Plan for an infant in care. This poses a potential health & safety risk to children in
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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:Tashima Daniel
LICENSING EVALUATOR NAME:Sherlynn Banas
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2024


LIC809 (FAS) - (06/04)
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