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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376623781
Report Date: 05/25/2022
Date Signed: 05/25/2022 03:09:08 PM

Document Has Been Signed on 05/25/2022 03:09 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:WILSON, SUSAN FAMILY CHILD CAREFACILITY NUMBER:
376623781
ADMINISTRATOR:SUSAN WILSONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 407-0218
CITY:IMPERIAL BEACHSTATE: CAZIP CODE:
91932
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
05/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:32 PM
MET WITH:Susan Wilson TIME COMPLETED:
03:00 PM
NARRATIVE
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On May 25th, 2022 at 1:30pm, Licensing Program Analyst (LPA) David Miller conducted an unannounced Annual Required Inspection and met with the licensee Susan Wilson. Also present in the home was staff Kate Pillet. LPA disclosed the purpose of the inspection and was granted facility entry by the Licensee. The licensee, Pillet and 12 daycare children, 1 child under two, 9 children aged 2-3, and two children age 6 were present in the facility during this inspection.

This facility is a three (3) bedroom, two(2) bathroom one (1) story home. Licensee accompanied LPA during this inspection. Licensee is using the following areas for daycare: living room, dining room, bedroom 1, and bathroom 1 and 2. Off Limit areas are Master Bedroom, Bedroom 3, laundry room, and are made inaccessible via a safety gate and/or doorknob lock.

The fire extinguisher and smoke/carbon monoxide detector met requirements. Hazardous items were observed inaccessible to children during this inspection. The licensee has available toys, play equipment and materials. Children play outside in the fenced backyard. Licensee was reminded that continuous supervision is to be given to children whenever engaged in outdoor activities. No bodies of water were observed on the premises during the inspection. Licensee stated there are no weapons in the home and LPA did not observe any firearms at the time of this inspection.

Licensee’s First Aid and CPR certifications expire in 04/22/2024. Licensee has required immunizations. Licensee Mandated Reporter training expired. The facility roster is maintained and was reviewed. The last fire and disaster drills were conducted and documented on 03/21/2022.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: David Miller
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2022
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: WILSON, SUSAN FAMILY CHILD CARE
FACILITY NUMBER: 376623781
VISIT DATE: 05/25/2022
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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.

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 reminded Licensee of 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.

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.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: David Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2022
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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: WILSON, SUSAN FAMILY CHILD CARE
FACILITY NUMBER: 376623781
VISIT DATE: 05/25/2022
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A deficiency was observed as per California Code of Regulations, (Title 22, Division 12 & Chapter 3), and is being cited on the attached LIC 809-D.

A copy of the report and appeal rights (LIC 9058) was provided to the applicant and notice of site visit (LIC9213) was given to Licensee and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the licensee Susan Wilson. 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/process







SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: David Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/25/2022 03:09 PM - It Cannot Be Edited


Created By: David Miller On 05/25/2022 at 02:05 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: WILSON, SUSAN FAMILY CHILD CARE
FACILITY NUMBER: 376623781

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/25/2022

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 interview and record review), the licensee did not comply with the section cited above. The mandated reporter trainig expired. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/17/2022
Plan of Correction
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The licensee stated that she will submit to the Agency proof of completing the mandated reporter training by 06/17/2022.
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:David Miller
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2022


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