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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376624129
Report Date: 04/21/2023
Date Signed: 04/21/2023 09:28:04 AM

Document Has Been Signed on 04/21/2023 09:28 AM - 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: DATE:
04/21/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:TIME COMPLETED:
09:40 AM
NARRATIVE
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On 4/21/23 at 8:00am Licensing Program Analysts (LPAs) Annette Sutherland and Gerald Poindexter arrived at the facility to conduct a case management inspection to follow up on a self reported incident that occurred on 4/19/23. Upon arrival, LPA met with Licensee, Nicoli Marsh. There were no children present at arrival .4 Children arrived shortly after. Operation hours are Monday to Friday from 8:00 am to 5:30pm.

On 4/19/23, child #1 (C1) was playing outside on the pull up bar when child fell and hit his head on the wood stump . Staff member #1 (SM1) observed C1 fall. Staff member assisted C1 and assessed the child for injuries. Licensee was in route from doctors appointment and staff member (SM1) called 911

LPA observed a pull up bar which measures 5ft ,There was a tree stump under the pull up bar for children to reach the bar. LPAs measured the stump area to the bar at 52 inches. Stump is 10 inches from bottom to top, 14 inches across in diameter. Stump has since been moved, if stump was imbedded 5 inches was exposed.

During today's visit LPA conducted interviews with Licensee and C1’s parent and obtained pictures of playground and C1's head wound. Based on the information gathered during today’s visit, age appropriate equipment and safety precautions were not in place.


Continued on LIC 809 C
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE: DATE: 04/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21/2023
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: MARSH, NICOLI FAMILY CHILD CARE
FACILITY NUMBER: 376624129
VISIT DATE: 04/21/2023
NARRATIVE
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See LIC809D for deficiency cited.


LPAs Annette Sutherland and Gerald Poindexter informed licensee Nicoli Marsh that this report dated 4/21/23 document(s) 1 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.
Also, LPAs Annette Sutherland and Gerald Poindexter informed the licensee to provide a copy of this licensing report dated 4/21/23 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.


An exit interview was conducted and appeal rights were provided to facility representative. A notice of site visit was provided and it shall remain posted at the facility for 30 days.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/21/2023 09:28 AM - It Cannot Be Edited


Created By: Annette Sutherland On 04/21/2023 at 08:55 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: 04/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/21/2023
Section Cited
CCR
102417(G)

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102417 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 be limited to… This requirement is not met as evidenced by:
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Licensee will provide a written statement on how she will assess playground equipment and areas for hazards before using equipment.
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Based on playground equipment age appropriate equipment was not being used.
This poses an immediate 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:Monica Cuddy
LICENSING EVALUATOR NAME:Annette Sutherland
LICENSING EVALUATOR SIGNATURE:
DATE: 04/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/21/2023


LIC809 (FAS) - (06/04)
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