<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376617294
Report Date: 06/22/2023
Date Signed: 06/22/2023 05:36:11 PM

Document Has Been Signed on 06/22/2023 05:36 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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:CERON, LETICIA FAMILY CHILD CAREFACILITY NUMBER:
376617294
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: 5DATE:
06/22/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Leticia CeronTIME COMPLETED:
05:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 6/22/2023 at 2:15 pm, Licensing Program Analyst (LPA) Vicky Williamson conducted an unannounced case management inspection to follow up on a self - reported incident report. Upon arrival, LPA Williamson met with Licensee, Leticia Ceron. LPA discussed the purpose of the inspection and proceeded to tour the facility. During the inspection there were five (5) children present, three (3) of whom were under 24 months.

On 6/2/2023, licensee self- reported an incident regarding an alleged possible lack of supervision involving Child 1 (C1) falling from a child's couch sustaining an injury. Per licensee, the alleged incident occurred on 6/1/2023, at about 10:20 am.

During today’s inspection, LPA conducted an interview with the licensee and authorized representative for C1. A review of the information indicated that the incident was an accident. There were no files available for review for C1 during the time of inspection.

During the tour of the facility, LPA observed Child #2 (C2), Child #3(C3) and Child #4 (C4) napping in bedroom 3, which is an "off limits" area. Licensee was reminded that prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed. LPA also observed C2 in a play yard with a fleece blanket covering their body. Licensee removed the blanket from the body of C2 and the children were immediately removed from the bedroom.

Per California Code of Regulations, Title 22, Division 12, Chapter 3, deficiencies are being cited. See LIC 809D.



An exit interview was conducted with Licensee, Leticia Ceron and a copy of this report, Appeal Rights, Confidential Names List, and LIC 809D were provided. Notice of Site Visit is required to be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE: DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/22/2023
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 3
Document Has Been Signed on 06/22/2023 05:36 PM - It Cannot Be Edited


Created By: Vicky Williamson On 06/22/2023 at 03:38 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: CERON, LETICIA FAMILY CHILD CARE
FACILITY NUMBER: 376617294

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/30/2023
Section Cited
CCR
102417(g)(7)

1
2
3
4
5
6
7
102417(g)The home shall be free from.. conditions... which might endanger a child... (7) An emergency information card...for each child... authorization for the licensee or registrant to consent to emergency medical care. This requirement is not met as evidenced by
1
2
3
4
5
6
7
Licensee stated that she will provide proof of records for C1 to LPA, no later than 6/30/2023.
8
9
10
11
12
13
14
Based on interview and record review, the licensee did not ensure records for C1 were available for review during time of inspection, which poses a potential, health, safety and personal rights risk to persons in care.
8
9
10
11
12
13
14
Type B
06/22/2023
Section Cited
CCR102416.(a)(6)

1
2
3
4
5
6
7
102416.3 (a)(6)Prior to making alterations... to a family child care home ..., the licensee shall notify the Department ...(6)Any change from an area of the family child care hoise previously identified as "off limits" ... The requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee stated that she will not use any off limit areas for childcare. Licensee provided LPA with a signed Declaration during the time of inspection. LIcensee removed C2, C3 & C4 from bedroom 3 during the time of inspection.
8
9
10
11
12
13
14
Based on LPA's observation, licensee did not comply with the above regulation, as LPA observed C2, C3 & C4 in bedroom 3 which is "off limits" which poses a potential, health, safety and personal rights risk to persons in care.
8
9
10
11
12
13
14
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:Tulam Vu
LICENSING EVALUATOR NAME:Vicky Williamson
LICENSING EVALUATOR SIGNATURE:
DATE: 06/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/22/2023


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 06/22/2023 05:36 PM - It Cannot Be Edited


Created By: Vicky Williamson On 06/22/2023 at 04:30 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: CERON, LETICIA FAMILY CHILD CARE
FACILITY NUMBER: 376617294

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/22/2023
Section Cited
CCR
102425(b)

1
2
3
4
5
6
7
Infant Safe Sleep (b) Cribs or play yards shall be free from all loose articles and objects.
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee removed C2 from under the blanket and from the play yard during the time of inspection. Licensee provided LPA with a signed Declaration during the time of inspection. Licensee stated that she understands the Safe Sleep Regulation.
8
9
10
11
12
13
14
Based on LPA's observation, licensee did not comply with the above regulation, as LPA observed C2 in a play yard napping,covered with a blanket in bedroom 3 which is off limits, which poses a potential, health, safety and personal rights risk to persons in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Tulam Vu
LICENSING EVALUATOR NAME:Vicky Williamson
LICENSING EVALUATOR SIGNATURE:
DATE: 06/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/22/2023


LIC809 (FAS) - (06/04)
Page: 3 of 3