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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376619146
Report Date: 07/19/2023
Date Signed: 07/19/2023 03:10:26 PM

Document Has Been Signed on 07/19/2023 03:10 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:TELESFOR FLORES, E. & SALOME TELESFOR, D. FCCFACILITY NUMBER:
376619146
ADMINISTRATOR:TELESFOR FLORES & SALOME TFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 847-6574
CITY:SAN DIEGOSTATE: CAZIP CODE:
92105
CAPACITY: 14TOTAL ENROLLED CHILDREN: 6CENSUS: 5DATE:
07/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Elisia Telesfor Flores & Dulce Salome TelesforTIME COMPLETED:
03:15 PM
NARRATIVE
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On July 19, 2023, at 11:20 AM, Licensing Program Analyst (LPA), Luigi Gargaro, conducted an unannounced annual required inspection and met with co-licensees , Elisia Telesfor Flores & Dulce Salome Telesfor. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensees. Five (5) children and the two co-licensees were present in the facility during this inspection. This facility is a two floor, two bedroom, two bathroom home. Licensees accompanied LPA inside and out of the facility during this inspection.

The following areas used for child care are: the living room and the day care bathroom located on the first floor of the home. Off limits areas are: the kitchen and the entire second floor of the home. The kitchen is made inaccessible with a secured safety gate that is installed at its entrance while the entire upstairs is made off limits with a child safety gate that is installed at the bottom of the home staircase

The fire extinguisher and smoke detector met requirements. All hazardous items were inaccessible to children. The licensee has toys, play equipment and materials available. The home has a fenced backyard available for outdoor activities. The yard has an off limits shed that contains the licensees' laundry equipment. It is made off limits with a high placed bolt and a locking door. Licensees have two additional storage areas that remain closed and off limits to day care children but state they will secure them further with the addition of bolts and/or locks and send analyst a photo demonstrating it.

Licensees also have a lower yard that belongs to the home that has no access to it from the upper yard and it can only be reached from a side entrance that children do not have access to. No bodies of water observed on the premises during the inspection. Licensees stated there are no weapons in the home. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2023
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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Document Has Been Signed on 07/19/2023 03:10 PM - It Cannot Be Edited


Created By: Luigi Gargaro On 07/19/2023 at 01:15 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: TELESFOR FLORES, E. & SALOME TELESFOR, D. FCC
FACILITY NUMBER: 376619146

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/19/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
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: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensees did not comply with the section cited above as they last conducted fire/earhquake drills in May of 2021 which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date: 07/31/2023
Plan of Correction
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Licensees state they will conduct both drills and send analyst a copy of their updated log by 07/31/23 to demonstrate completion of the correction.
Type B
Section Cited
CCR
102425(j)(2)(A)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following: Labored breathing.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensees did not comply with the section cited above as they were not maintining a safe sleep log for the one infant they have in care, Child #1, which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date: 07/31/2023
Plan of Correction
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Licensees were provided with a sample safe sleep log and will start documenting the infant's sleep as required going forward. Licensees will send LPA a sample of the sleep log for the period of 07/20/23-07/28/23 by 07/31/23 to demonstrate correrction of the deficiency.
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:Jason Garay
LICENSING EVALUATOR NAME:Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:
DATE: 07/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/19/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/19/2023 03:10 PM - It Cannot Be Edited


Created By: Luigi Gargaro On 07/19/2023 at 01:15 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: TELESFOR FLORES, E. & SALOME TELESFOR, D. FCC
FACILITY NUMBER: 376619146

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/19/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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 licensees did not comply with the section cited above as they did not have a current Mandated Reporter Training certificate which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date: 08/21/2023
Plan of Correction
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Licensees were provided with a flyer for the on-line Mandated Reporter Training at www.mandatedreporterca.com and state they will both sign up for and complete the training and submit a copy of their certificates to analyst by 08/21/23 to correct the deficiency.
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensees did not comply with the section cited above as Child #1 did not have an immunization record on file which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date: 07/24/2023
Plan of Correction
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Licensees state they will obtain a copy of the child in question's immunization record and place it on a PMS286 immunization record as required and then submit it to analyst by 07/24/23 to complete the correction.
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:Jason Garay
LICENSING EVALUATOR NAME:Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:
DATE: 07/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/19/2023


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: TELESFOR FLORES, E. & SALOME TELESFOR, D. FCC
FACILITY NUMBER: 376619146
VISIT DATE: 07/19/2023
NARRATIVE
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Both co-licensee's First Aid and CPR certifications expire in December of 2024. Licensees have their required immunizations. Licensees do not have current Mandated Reporter Training certifications. Facility roster is maintained and was reviewed. The last fire and disaster drills were conducted and documented in May of 2021. There is 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. The provider physically checks on sleeping infants every 15 minutes but has not been maintaining a safe sleep log for the one infant in care. An Individual Infant Sleeping Plan [LIC 9227 (3/20)] is maintained for each infant up to 12 months of age. The provider places infants up to 12 months of age on their backs for sleeping.

LPA provided and discussed the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, and ensure that all adults residing or working in the home have criminal background clearances or exemptions. 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 handouts with information regarding upcoming Safe Sleep Regulations/SIDS, Lead exposure and Shaken Baby Syndrome. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

LPA discussed and provided Licensee with the following: child care advocates email address: childcareadvocatesprogram@dss.ca.gov . In addition, for general questions or questions regarding licensing requirements contact the Child Care Licensing Duty Line at (619) 767-2248. Unusual Incident Reports may be e-mailed to: SDIncidentReports@dss.ca.gov

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.

Four type B violations California Code of Regulations, (Title 22, Division 12 & Chapter 3), are being cited on the attached LIC 809-D.

An exit interview was conducted with the licensees. The licensees were provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.

LPA provided notice of site visit and observed it being posted at the facility
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023
LIC809 (FAS) - (06/04)
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