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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376622674
Report Date: 07/20/2023
Date Signed: 07/20/2023 05:15:21 PM

Document Has Been Signed on 07/20/2023 05:15 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:GUZMAN, LOREN FAMILY CHILD CAREFACILITY NUMBER:
376622674
ADMINISTRATOR:LOREN GUZMANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 232-2079
CITY:SAN DIEGOSTATE: CAZIP CODE:
92113
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
07/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Loren GuzmanTIME COMPLETED:
01:00 PM
NARRATIVE
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On 7/20/2023, at 11:00 a.m., Licensing Program Analyst (LPA), Cindy Meier conducted an unannounced Annual Inspection and met with Licensee, Loren Guzman. LPA disclosed the purpose of the inspection and was led on a tour of the facility indoors and outdoors. This facility is a one story, three-bedroom, two bathroom house. The following areas are used for childcare: living room, bathroom, and outside covered play area. Off limits areas include: kitchen, garage, bedrooms #1, #2, #3 which are made inaccessible through the use baby gates, locks and doorknob covers. Hours of operation hours are Monday – Sunday 5:00 a.m. to 10:30 p.m. There were eight (8) children present during the inspection, two (2) infants, five (5) preschoolers, and one (1) school age, one (S1) assistant, and licensee’s daughter.

The fire extinguisher, smoke detector and carbon monoxide detector met requirements. Hazardous items were inaccessible to children in care. LPA informed licensee poisons shall be placed in a storage area and locked. LPA did not observe any poisons during the inspection. The storage area for poisons is locked. LPA observed toys and materials available for children’s use. The home has a covered, fenced, side patio available for outdoor activities. LPA informed licensee to ensure children are supervised at all times during outdoor activities. There is no fireplace on the premises. Licensee stated there are no bodies of water and LPA did not observe any bodies of water during the inspection. Licensee stated there are no firearms, other weapons, or ammunition 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.

LPA reviewed children’s files. Children’s files reviewed were complete and met regulations.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Cindy Meier
LICENSING EVALUATOR SIGNATURE: DATE: 07/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2023
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 6
Document Has Been Signed on 07/20/2023 05:15 PM - It Cannot Be Edited


Created By: Cindy Meier On 07/20/2023 at 11:54 AM
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: GUZMAN, LOREN FAMILY CHILD CARE
FACILITY NUMBER: 376622674

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/20/2023

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 analyst observation and interview, the licensee did not comply with the section cited above as she has not been conducting fire and disaster drills every six months as required which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date: 07/26/2023
Plan of Correction
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Licensee was provided with a blank fire/earthquake drill log and states will conduct both drills with the children in care this week and then continue to do so once every six months as required by regulation. Licensee states she will submit a copy of the completed drill log to analyst by 07/26/23 to complete the correction.
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on analyst interview and record review, the licensee did not comply with the section cited above as she is not documenting the infant she has in care's sleeping status every 15 minutes as required by regulation which poses/posed a potential health, safety or personal rights risk to the child in care.
POC Due Date: 07/28/2023
Plan of Correction
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Licensee was provided with a sample Safe Sleep log and stated she will begin documenting infants sleeping status every 15 minutes. Licensee will send a copy of the completed log for the dates of 7/20/23 - 7/28/23 to analyst by 7/28/23.
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:Cindy Meier
LICENSING EVALUATOR SIGNATURE:
DATE: 07/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/20/2023 05:15 PM - It Cannot Be Edited


Created By: Cindy Meier On 07/20/2023 at 11:54 AM
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: GUZMAN, LOREN FAMILY CHILD CARE
FACILITY NUMBER: 376622674

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/20/2023

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 observation and Licensee's statement that she has not taken the Mandated Reporter Training, the licensee did not comply with the section cited above in that she or S1 has not completed the Mandated Reporter Training course, which poses as a potential health, safety or personal rights risk to persons in care.

POC Due Date: 08/21/2023
Plan of Correction
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LPA provided Licensee with written instructions on how to locate the Mandated Reporter Training online. Licensee states she and S1 will complete this online course and provide LPA with a copy of their training completion certificate no later than 08/21/2023.


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 observation, interview and record review the licensee did not have the required immunization's on file for licensee,and S1 which poses as a potential health, safety or personal rights risk to persons in care.

POC Due Date: 08/04/2023
Plan of Correction
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Licensee stated she will obtain copies of licensee's and S1's immunization's and submit a copy to the CCLD office by 8/4/23.
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:Cindy Meier
LICENSING EVALUATOR SIGNATURE:
DATE: 07/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2023


LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 07/20/2023 05:15 PM - It Cannot Be Edited


Created By: Cindy Meier On 07/20/2023 at 11:54 AM
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: GUZMAN, LOREN FAMILY CHILD CARE
FACILITY NUMBER: 376622674

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/20/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.1(a)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information:

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 that required forms for S1 were not on file and available for review which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/04/2023
Plan of Correction
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Licensee stated she will ensure S1 fills out required forms and creates a personnel file for assistant.
Licensee will submit copies of completed forms to CCLD by 8/4/23.
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

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 in not having the required LIC 9227 Individual Sleeping Plan for infants in care which poses a potential health, safety to persons in care.
POC Due Date: 07/28/2023
Plan of Correction
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Licensees stated that they will ensure to fill out the required form LIC-9227 with the parents and will send a copy of completed signed form to the LPA as proof of correction by the due date of 7/28/23.

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:Cindy Meier
LICENSING EVALUATOR SIGNATURE:
DATE: 07/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2023


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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: GUZMAN, LOREN FAMILY CHILD CARE
FACILITY NUMBER: 376622674
VISIT DATE: 07/20/2023
NARRATIVE
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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.

Licensee and S1 have not completed Mandated Reporter AB1207 training. Pediatric CPR and First Aid certifications expire in 7/2023. Licensee and S1 immunizations were not available for review. Facility roster is maintained and was reviewed. The last fire and disaster drills were conducted and documented in 2019. Required documents are posted. There is one crib or play yard for each infant who is unable to climb out of the crib or play yard.

Incidental Medical Services (IMS) policy were discussed. 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 discussed 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 and licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov. LPA discussed and provided Licensee with the following: childcare 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.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Cindy Meier
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023
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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: GUZMAN, LOREN FAMILY CHILD CARE
FACILITY NUMBER: 376622674
VISIT DATE: 07/20/2023
NARRATIVE
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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication. LPA reviewed with licensee the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

Per California Code of Regulations, (Title 22, division 12 & Chapter 3) six (6) Type B citations are being cited on the attached LIC 809-D.

Exit interview conducted and report was reviewed with licensee, Loren Guzman. A copy of this report, along with Appeal Rights (LIC9058), were provided. A notice of site visit was given and must remain posted for 30 days. LPA observed that the notice of site visit was posted during the inspection. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Cindy Meier
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023
LIC809 (FAS) - (06/04)
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