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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376623091
Report Date: 01/19/2023
Date Signed: 01/19/2023 03:36:40 PM

Document Has Been Signed on 01/19/2023 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:SCHAFFER, FLORA FAMILY CHILD CAREFACILITY NUMBER:
376623091
ADMINISTRATOR:FLORA SCHAFFERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 539-6041
CITY:SAN DIEGOSTATE: CAZIP CODE:
92122
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
01/19/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Licensee, Flora Schaffer TIME COMPLETED:
12:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Jennifer Lott conducted an unannounced case management visit to cite unrelated deficiencies noted during a previous visit from 01/19/2023. Licensee, Flora Schaffer was informed of the violation. During the 11/14/2022 site visit, Licensee was unable to provide child #1’s file. Licensee stated that the documents had been discarded.

Therefore, a deficiency is being cited per Title 22, Div. 6, Chap 6 Regulations and listed on the attached LIC 809-D. An exit interview was conducted and report was reviewed with Licensee Schaffer. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Jennifer Lott
LICENSING EVALUATOR SIGNATURE: DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/19/2023
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 2
Document Has Been Signed on 01/19/2023 03:36 PM - It Cannot Be Edited


Created By: Jennifer Lott On 01/19/2023 at 12:09 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: SCHAFFER, FLORA FAMILY CHILD CARE
FACILITY NUMBER: 376623091

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/31/2023
Section Cited
CCR
102421(a)

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Child’s Records - … “ The licensee shall keep the signed and dated notice form for at least three years following termination of service to the child.” This requirement is not met as evidenced by:
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Licensee will provide a signed declaration stating that they have a clear understanding that all Family Child Care Records shall be kept for at least 3 years following the termination of service to the child.

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On 11/14/22, LPA requested C1’s records. Licensee states that C1’s records had been discarded. This poses a potential health and safety risk to children in care.
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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:Tashima Daniel
LICENSING EVALUATOR NAME:Jennifer Lott
LICENSING EVALUATOR SIGNATURE:
DATE: 01/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/19/2023


LIC809 (FAS) - (06/04)
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