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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376617087
Report Date: 07/27/2022
Date Signed: 07/27/2022 04:43:08 PM

Document Has Been Signed on 07/27/2022 04:43 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:WILLARD, LISA FAMILY CHILD CAREFACILITY NUMBER:
376617087
ADMINISTRATOR:LISA WILLARDFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 717-9373
CITY:SAN DIEGOSTATE: CAZIP CODE:
92117
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
07/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Lisa WillardTIME COMPLETED:
05:00 PM
NARRATIVE
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Licensing Program Analysts (LPAs), Saraliz Velando and Adrian Mangina conducted an unannounced Annual Licensing Inspection. LPAs were greeted at the front door by Lisa Willard and granted entry after identifying themselves and disclosing the purpose of the visit. The licensee is using the following areas for daycare: Family room, Front room, Bathroom #1, Dining room, Kitchen, Daycare room, and Backyard. Off limit areas include: Bedroom #1, Bedroom #2, Bedroom #3, Bedroom #4, Bathroom 2, Bathroom 3, and Garage. Licensee utilizes Backyard for outdoor play and LPAs observed several hazards including uncovered BBQ grill, chairs, tables, and ladder leaning against the fence, tripping hazards including rocks, landscape pavers, and hole in artificial turf approximately 1x1 foot area that is sunken approximately 2 inches. Business Hours are: Monday-Friday, 7:30am-4:00pm. The facility currently has 9 children in care. Licensee provided a copy of their current roster and is operating within the licensed ratio and capacity.

LPA tested the smoke alarm and carbon monoxide alarm. Fire extinguisher located in the daycare room 3-A-40-BC meets regulations. There are no bodies of water on the property. Licensee, stated there are no weapons or ammunition stored on the premises.

Fireplaces are screened to prevent access by children. Stairs to second floor is gated. LPAs observed in the kitchen several drawers contained batteries, knives, and other unsafe items, licensee was instructed to remove unsafe items. The last disaster/fire drill was conducted on 3/12/22. The home is kept clean and orderly with heating and ventilation for safety and comfort. The home provides safe toys, play equipment and materials.

LPAs reviewed 9 children’s files and observed child 1, 4, and 7 did not have Safe Sleep Logs, Licensee advised to ensure daily logs are kept for all infants in care. LPAs observed child 4 and child 7 is missing Immunization record and child 9 has no file and child 8 missing lIC9150 and LIC282.

(continued on LIC 809-C)
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Saraliz Velando
LICENSING EVALUATOR SIGNATURE: DATE: 07/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/27/2022
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 7
Document Has Been Signed on 07/27/2022 04:43 PM - It Cannot Be Edited


Created By: Saraliz Velando On 07/27/2022 at 02:45 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: WILLARD, LISA FAMILY CHILD CARE
FACILITY NUMBER: 376617087

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
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:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above, hazardous items were found in Backyard and Kitchen which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/17/2022
Plan of Correction
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Licensee stated will remove knives, batteries, and medication from kitchen drawers and will remove tables, chairs, and ladder from Backyard. Licensee will install a fence to separate children from hazards which is scheduled for the end of August. Licensee will provide proof of installation no later than 8/17/22.
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 review, the licensee did not comply with the section cited above as licensee and assistant do not have Mandated Reporter Certificates which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/17/2022
Plan of Correction
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Licensee states will ensure her and assistant complete the Mandated Reporter Training and provide proof of completion no later than 8/17/22.
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:Saraliz Velando
LICENSING EVALUATOR SIGNATURE:
DATE: 07/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2022


LIC809 (FAS) - (06/04)
Page: 4 of 7
Document Has Been Signed on 07/27/2022 04:43 PM - It Cannot Be Edited


Created By: Saraliz Velando On 07/27/2022 at 02:45 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: WILLARD, LISA FAMILY CHILD CARE
FACILITY NUMBER: 376617087

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

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 as assistant has no personnel file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/17/2022
Plan of Correction
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Licensee states she will create and maintain a personnel file for her assistant and provide proof no later than 8/17/22.
Type B
Section Cited
CCR
102419(d)
Admission Procedures and Parental and Authorized Representative's Rights
(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05).

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 as 1 of 9 children did not have a file and 2 of 9 children did not an immunization record, 1 of 9 children did not have LIC9150 and LIC282 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/17/2022
Plan of Correction
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Licensee states she will ensure every child in care has all required documents in each child's file. Licensee will provide this proof no later than 8/17/22.
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:Saraliz Velando
LICENSING EVALUATOR SIGNATURE:
DATE: 07/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2022


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: WILLARD, LISA FAMILY CHILD CARE
FACILITY NUMBER: 376617087
VISIT DATE: 07/27/2022
NARRATIVE
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(LIC809-C, page 2)
Licensee’s Pediatric CPR and First Aid cards are current and will expire on May 2024. Licensee and assistant do not have current Mandated Reporter Certificates. Assistant has no personnel file. There is a working telephone and email address.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain 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.

LPAs discussed the safe sleep regulations with licensee or facility representative 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 for facility representative 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.

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.

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/inspection-process.

(continued on LIC809-C)
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Saraliz Velando
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2022
LIC809 (FAS) - (06/04)
Page: 7 of 7
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: WILLARD, LISA FAMILY CHILD CARE
FACILITY NUMBER: 376617087
VISIT DATE: 07/27/2022
NARRATIVE
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(LIC809-C page 3)
Based on today’s visit, deficiencies were observed and noted on the attached LIC 809D.

Exit interview conducted and report was reviewed with the licensee, Lisa Willard. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Saraliz Velando
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2022
LIC809 (FAS) - (06/04)
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