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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376624129
Report Date: 01/26/2022
Date Signed: 01/26/2022 12:44:08 PM

Document Has Been Signed on 01/26/2022 12:44 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:MARSH, NICOLI FAMILY CHILD CAREFACILITY NUMBER:
376624129
ADMINISTRATOR:NOCOLI MARSHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 505-9457
CITY:SAN DIEGOSTATE: CAZIP CODE:
92111
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
01/26/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Nicoli MarshTIME COMPLETED:
01:00 PM
NARRATIVE
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On 1/26/22 at 11:00 AM Licensing Program Analyst (LPA) Adrian Mangina was at the facility regarding another matter. LPA met with Licensee Nicoli Marsh. Also present in the home was License''s husband and Assistant Joshua Marsh and eight daycare children. At 10:30 AM Assistant Rym Mouelhi arrived to assist in the care for the children.

During the visit LPA observed the following deficiencies: Child roster is not current, staff #1 and Staff #2 files are missing mandated reporter training certificates, and Staff #1 file is missing immunization record, LIC508 Criminal Record Statement and LIC9052 Employee Rights.

See LIC809- Ds for deficiencies cited.

Exit interview conducted with Licensee. A copy of this report (LIC9099) was provided. The Notice of Site Visit was provided and Licensee is advised it must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2022
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 3
Document Has Been Signed on 01/26/2022 12:44 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 01/26/2022 at 11:19 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: MARSH, NICOLI FAMILY CHILD CARE
FACILITY NUMBER: 376624129

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/02/2022
Section Cited
CCR
102417(g)(8)

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OPERATION OF A FAMILY CHILD CARE HOME:Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement was not met as evidenced by:
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Licensee states will provide LPA an updated roster no later than close of business 2/2/22
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Based on file review and Licensee statement roster is not updated to include current children in care which poses a potential safety, health and personal rights risk to children in care.
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Type B
02/02/2022
Section Cited
HSC1597.622(a)(1)

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Employees or volunteers at Family Child Care Home: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles...

This requirement was not met as evidenced by:
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Licensee states will provide LPA with complete personel file for Staff #1 no later than 2/2/22.
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Based on file review Staff #1 file is missing proof of immunizations against measles and pertussis which poses a potential health, safety or personal rights 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:Renesha Pack
LICENSING EVALUATOR NAME:Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2022


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 01/26/2022 12:44 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 01/26/2022 at 11:44 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: MARSH, NICOLI FAMILY CHILD CARE
FACILITY NUMBER: 376624129

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/02/2022
Section Cited
HSC
1596.8662(a)(3)

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Availability of information regarding detecting and reporting child abuse ...employee of a licensed child day care facility shall complete the mandated reporter training ...and shall complete renewal mandated reporter training every two years...

This requirement was not met as evidenced by:
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LIcensee stated will provide LPA proof that staff #1 and staff #2 have completed mandated reporter training no later that close of business 2/2/22.
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Based on file review Staff 1 and staff 2 did not have mandated reporter training certificates in file which poses a potential health, safety or personal rights 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:Renesha Pack
LICENSING EVALUATOR NAME:Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2022


LIC809 (FAS) - (06/04)
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