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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376624129
Report Date: 02/25/2022
Date Signed: 02/25/2022 12:30:20 PM

Document Has Been Signed on 02/25/2022 12:30 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:
02/25/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:TIME COMPLETED:
12:45 PM
NARRATIVE
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On 2/25/22 at 12:15 PM 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 Licensee Assistant Rym Mouelhi, seven children in care and Licensee's own minor child. Proper supervision and ratios were observed.

During the visit LPA observed the following deficiency: incident report for Child #1 was not submitted as required.

See LIC809 - D for deficiency cited.

Exit interview conducted with Licensee. . A copy of this report (LIC809) was provided. Licensee's signature acknowledges receipt. 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: 02/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/25/2022
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 2
Document Has Been Signed on 02/25/2022 12:30 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 02/25/2022 at 09:30 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: 02/25/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/04/2022
Section Cited
CCR
102416.2(c)(3)

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REPORTING REQUIREMENTS:...the licensee shall report the following events to the Department: A communicable disease outbreak when determined by the local health authority.

This requirement was not met as evidenced by:
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Licensee states that she will submit to LPA a completed LIC624B regarding child #1 no later than close of business 3/4/22 and will in future contact Licensing and San Diego County Public health within 24 hours of a confirmed covid case and within 7 days submit to CCLD a written LIC624B with details of the incident as required by regulation.
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Based on record review and Licensee statement, Licensee did not report covid case to Licensing or public health department as required which poses a potential health, safety and 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: 02/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/25/2022


LIC809 (FAS) - (06/04)
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