376619146-5-6-2025-20-CC-LGAO-DGESZT-20250506141941

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376619146
Report Date: 05/06/2025
Date Signed: 05/06/2025 03:36:09 PM

Document Has Been Signed on 05/06/2025 03:36 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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	TELESFOR FLORES, E. & SALOME TELESFOR, D. FCC		FACILITY NUMBER:	376619146
ADMINISTRATOR/ DIRECTOR:	TELESFOR FLORES & SALOME T		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 847-6574
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92105
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 4	DATE:	05/06/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:30 AM
MET WITH:	Dulce Salome Telesfor and Elisia Telesfor Flores		TIME VISIT/ INSPECTION COMPLETED:	02:30 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 May 6, 2025, at 10:30 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. Four (4) 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 carbon monoxide detector met requirements. All hazardous items were inaccessible to children. The licensee has toys, play equipment and materials available. The home has a walled and shaded enclosed patio area immediately behind the living room that is available for outdoor activities. The patio area has an off limits shed that contains the licensees' personal items. It is made off limits with a high placed bolt and a locking door. Licensees have two additional storage areas that are off limits to day care children and are made that way with either bolts or installed locks. Licensees also have a lower yard that belongs to the home that has no access to it from the enclosed patio 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.

NAME OF LICENSING PROGRAM MANAGER: Jason Garay
NAME OF LICENSING PROGRAM ANALYST: Luigi Gargaro
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/06/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025

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 8

California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

Page: 2 of 8

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: 05/06/2025

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
26
27
28
29
30
31
32

Both co-licensees' First Aid and CPR certifications expire in January of 2027. Licensees have their required immunizations. Licensees do not have current Mandated Reporter Training certifications. Facility roster is maintained and was reviewed. Fiire and disaster drills have not been conducted in the last six months. 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 were not 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 infant in care. An Individual Infant Sleeping Plan [LIC 9227 (3/20)] is not 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.

Five 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 for the licensees to post in their notification area for 30 days.

NAME OF LICENSING PROGRAM MANAGER: Jason Garay
NAME OF LICENSING PROGRAM ANALYST: Luigi Gargaro
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/06/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025

LIC809 (FAS) - (06/04)

Page: 3 of 8

Document Has Been Signed on 05/06/2025 03:36 PM - It Cannot Be Edited

Created By: Luigi Gargaro On 05/06/2025 at 12:40 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: 05/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(1)

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: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on analyst observation, the licensees did not comply with the section cited above as their smoke detector was not operating today which poses/posed a potential health, safety or personal rights risk to children in care.
	POC Due Date: 05/12/2025
	Plan of Correction
1 2 3 4	Licensees stated that they ordered new batteries for the detector on-line and that they shoiuld be arriving within the next few days. Licensees stated that they will send analyst a copy of their purchase receipt and a video demonstrating the successful testing/operation of the detector by 05/12/25 to demonstrate completion of the correction

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
1 2 3 4	Based on record review, the licensees did not comply with the section cited above as they have not conducted fire or earthquake drills within the past six months which poses/posed a potential health, safety or personal rights risk to children in care.
	POC Due Date: 05/19/2025
	Plan of Correction
1 2 3 4	Licensees state they will conduct both drills and send analyst a copy of their updated log by 05/19/25 to demonstrate completion of 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.

	Jason Garay
NAME OF LICENSING PROGRAM MANAGER:

	Luigi Gargaro
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/06/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025

LIC809 (FAS) - (06/04)

Page: 4 of 8

Document Has Been Signed on 05/06/2025 03:36 PM - It Cannot Be Edited

Created By: Luigi Gargaro On 05/06/2025 at 12:40 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: 05/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(a)(3)

Infant Safe Sleep

(a) There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. (3) Mattresses shall be firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the mattress so it cannot be dislodged. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on analyst observation, the licensees did not comply with the section cited above as the play yard that the infant was in today did not have a fitted sheet on the mattress but instead a tucked in blanket which poses/posed a potential health, safety or personal rights risk to children in care.
	POC Due Date: 05/12/2025
	Plan of Correction
1 2 3 4	Licensees state that they have a fitted sheet for the crib but it was being washed. Licensees stated they will put the sheet back and send analyst a photo of it by 05/12/25 demonstrating that the deficiency is corrected.

Type B

Section Cited

CCR

102425(j)(2)(B)

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: Signs of distress which includes but is not limited to flushed skin color, increase in body temperature and restlessness. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	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 infant they have in care, Child #1, since October of 2024 which poses/posed a potential health, safety or personal rights risk to children in care.
	POC Due Date: 05/19/2025
	Plan of Correction
1 2 3 4	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 05/07/25 - 05/16/25 by 05/19/25 to demonstrate correction 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.

	Jason Garay
NAME OF LICENSING PROGRAM MANAGER:

	Luigi Gargaro
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/06/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025

LIC809 (FAS) - (06/04)

Page: 5 of 8

Document Has Been Signed on 05/06/2025 03:36 PM - It Cannot Be Edited

Created By: Luigi Gargaro On 05/06/2025 at 12:40 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: 05/06/2025

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
1 2 3 4	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: 06/09/2025
	Plan of Correction
1 2 3 4	Licensee stated she believes that she completed the mandated reporter training after last annual visit but could not find record of it. Licensee will continue to search for it and if cannot locate it in her e-mail history states that she and her co-licensee mother will take the on-line Mandated Reporter Training course at www.mandatedreporterca.com and then submit a copy of their certificates of completion to analyst by 06/09/25 to correct the deficiency.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Jason Garay
NAME OF LICENSING PROGRAM MANAGER:

	Luigi Gargaro
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/06/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025

LIC809 (FAS) - (06/04)

Page: 6 of 8