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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376617352
Report Date: 07/31/2023
Date Signed: 07/31/2023 04:03:16 PM

Document Has Been Signed on 07/31/2023 04:03 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:RODRIGUEZ, NORA FAMILY CHILD CAREFACILITY NUMBER:
376617352
ADMINISTRATOR:NORA RODRIGUEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 690-9507
CITY:SAN DIEGOSTATE: CAZIP CODE:
92154
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 0DATE:
07/31/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Nora RodriguezTIME COMPLETED:
04:00 PM
NARRATIVE
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On July 31, 2023, at 1:30 p.m., Licensing Program Analyst (LPA), Gloria Gonzalez conducted an unannounced Annual Required Inspection and met with the Licensee, Nora Rodriguez.  LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee.  No daycare children and no staff members were present in the facility during this inspection. This facility is a one story, 3bedroom, 2 bathroom house. Licensee accompanied LPA inside and out of the facility during this inspection. The following areas used for child care are: living room 1 & 2 (playroom), dining room, kitchen, hallway bathroom, master bedroom, master bathroom, front yard and side yard. Off limits areas are other side of yard, garage, two bedrooms, and are inaccessible through use of door knob covers. Hours of operation are: Monday- Sunday from 1:00 am-12:00 am.

The fire extinguisher, smoke detector, and carbon monoxide detector met requirements.  Hazardous items were made inaccessible to children during the inspection. The licensee has toys, play equipment and materials available.  The home has a fenced backyard and side yard, available for outdoor activities at time of inspection. No bodies of water observed on the premises during the inspection. Licensee stated there are no weapons in the home. A review of staff records on this date indicates that not all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances. At 1:45 pm Licensee stated there are 4 individuals living in the motor home at this address and 3 of them have not received criminal record and child abuse clearances. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a 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.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Gloria Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 07/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/31/2023
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: RODRIGUEZ, NORA FAMILY CHILD CARE
FACILITY NUMBER: 376617352
VISIT DATE: 07/31/2023
NARRATIVE
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Licensee’s First Aid and CPR certification expires on 5/2024.  Licensee has required immunizations.  Licensee has not completed Mandated Reporter Training as she was not aware of this training being available in Spanish. Facility roster is maintained and was reviewed. The last fire and disaster drills were conducted and documented on 2/10/23. 

Licensee was advised if there is to be an infant in care, there must be one crib or play yard for each infant who is unable to climb out of the crib or play yard.  Cribs or play yards are free from all loose articles and objects. Licensee shall physically check on sleeping infants up to 24 months of age every 15 minutes.  An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be maintained for each infant up to 12 months of age.Licensee shall place infants up to 12 months of age on their backs for sleeping. LPA discussed the safe sleep regulations with licensee 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 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.

LPA provided and discussed the following:  Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms.  Licensee was reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers and/or similar equipment are not allowed in daycare.  Licensee was also provided information regarding SIDS, Lead exposure and Shaken Baby Syndrome. LPA and Licensee discussed California Megan's Law and LPA provided:www.meganslaw.ca.gov. 
LPA advised if there is an unusual incident to report to call Licensing within 24 hours and to follow up with an LIC624B within 7 days. In addition, for general questions, questions regarding licensing requirements call Child Care Licensing.

Duty Line at (619) 767-2248. Access our updated Regulation & Forms by using our WEBSITE: http://ccld.ca.gov.

LPA discussed and provided Licensee with the following: child care advocates email address: childcareadvocatesprogram@dss.ca.gov.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Gloria Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2023
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: RODRIGUEZ, NORA FAMILY CHILD CARE
FACILITY NUMBER: 376617352
VISIT DATE: 07/31/2023
NARRATIVE
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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.

LPA advised the Licensee that prior to making alterations or additions to the home or grounds, the Licensee shall notify the Department of the proposed change.

LPA, Gloria Gonzalez informed Licensee, Nora Rodriguez that this report dated 7/31/23 documents a Type A citation which shall be posted for 30 consecutive days as there is/are an immediate risk to the health, safety, or personal rights of children in care.

Type B deficiency is being cited during today's inspection, see LIC809D.

Also, LPA, Gloria Gonzalez informed the Licensee, Nora Rodriguez to provide a copy of this licensing report dated 7/31/23 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. Civil Penalty was assessed in the amount of $1.500, see LIC421.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

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.

A copy of the report and appeal rights (LIC 9058) and notice of site visit (LIC9213) was provided to Licensee and must remain posted for 30 days. LPA interpreted and explained the inspection report to licensee in Spanish, licensee stated she understood.

An exit interview was conducted and report was reviewed with the licensee, Nora Rodriguez.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Gloria Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/31/2023 04:03 PM - It Cannot Be Edited


Created By: Gloria Gonzalez On 07/31/2023 at 03:10 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: RODRIGUEZ, NORA FAMILY CHILD CARE
FACILITY NUMBER: 376617352

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/31/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d((1)
Criminal Record Clearance (d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in not ensuring all adults living in the home have a criminal record clearances, as three adults that live at this same address have not been cleared, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/01/2023
Plan of Correction
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Licensee states she will have the three individuals take the LIC9163 form to a LIve Scan office today and will email a copy of the form to the department by 8/1/23.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Tulam Vu
LICENSING EVALUATOR NAME:Gloria Gonzalez
LICENSING EVALUATOR SIGNATURE:
DATE: 07/31/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/31/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/31/2023 04:03 PM - It Cannot Be Edited


Created By: Gloria Gonzalez On 07/31/2023 at 03:19 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: RODRIGUEZ, NORA FAMILY CHILD CARE
FACILITY NUMBER: 376617352

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/31/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102369(b)(9)
102369(b)(9) Application for Initial License (b)The applicant shall provide all of the following information at the time of submission of the application: (9) Evidence of a current tuberculosis clearance... for any adult in the home during the time that children are under care. This requirement was not met as evidenced by:


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in not ensuring that all adults living in the home have a tuberculosis clearance, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/31/2023
Plan of Correction
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Licensee states she will have the three individuals obtain a tuberculosis test and will send the deparmtent the results by 8/31/23.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Tulam Vu
LICENSING EVALUATOR NAME:Gloria Gonzalez
LICENSING EVALUATOR SIGNATURE:
DATE: 07/31/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/31/2023


LIC809 (FAS) - (06/04)
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