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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376624276
Report Date: 05/31/2024
Date Signed: 05/31/2024 02:19:17 PM

Document Has Been Signed on 05/31/2024 02:19 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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:CIBRIAN, ROSA FAMILY CHILD CAREFACILITY NUMBER:
376624276
ADMINISTRATOR/
DIRECTOR:		ROSA CIBRIANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 852-6452
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 12DATE:
05/31/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Rosa Cibrian and Amy CibrianTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On 5/31/2024, at 10:30am, Licensing Program Analyst (LPA), Vicky Williamson conducted an unannounced annual random inspection. LPA met with Licensee Rosa Cibrian and disclosed the purpose of the inspection. Also present was licensee's assistants Jose Herrera and Amy Cibrian. Assistant Amy Cibrian aided as a translator due to licensee’s primary language is Spanish. There were 12 daycare children present, one of whom is an infant. Days and hours of operation are Monday through Friday, 6:00am - 6:00pm.

This is a one story three bedroom, two bath home. LPA accompanied by Licensee, Rosa Cibrian toured the indoor and outdoor of the home. The following areas are used for childcare: dining room, living room, playroom room, hallway bathroom and the backyard. The off-limits areas are the kitchen, bedroom #1 (master), bedroom #2, bedroom #3, bathroom #1 (inside of master), storage shed (backyard), laundry room, and the garage. They are made inaccessible to day care children by use of locks and child safety gates. Licensee utilizes the backyard for outdoor activities of children.Licensee was reminded that to provide supervision of children during outdoor activity. Licensee updated the facility sketch during time of inspection.


LPA advised the Licensee that prior to making alterations or additions to the home or grounds, the Licensee shall notify the Department of the proposed change.

The fire extinguisher, smoke and carbon monoxide detectors meet requirements and are operational. Poisons, detergents, cleaning compounds, medications and other hazardous items were made inaccessible. Licensee has children's toys, play equipment and books available. Licensee has a home phone and a working cell phone. Licensee stated that there are no bodies of water on the premises. Licensee stated there are firearms and ammunition in the home. LPA verified that the firearms are stored and locked and ammunition stored separately.

See LIC 809C Continuation...

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE: DATE: 05/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/31/2024
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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: CIBRIAN, ROSA FAMILY CHILD CARE
FACILITY NUMBER: 376624276
VISIT DATE: 05/31/2024
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Pediatric CPR/First Aid certification for License, Rosa Cibrian and Assistant Jose Herrera are valid through 6/2025; Assistant Amy Cibrian valid through 5/20/2026. Licensee and assistants have the required immunization records on file. Mandated Reporter training certification for licensee is valid through 6/2025, Licensee, Rosa Cibrian 6/30/2025, Assistant Jose Herrera 12/6/2025 and Assistant Amy Cibrian is valid 9/28/2025. LPA informed licensee to ensure the mandated reporter training is completed once every two years. LPA observed the required documents posted. A sample of children’s files were reviewed and were determined to be incomplete. Sleep log and individual Sleeping Plan for Child #1 was not available for review during time of inspection. The last fire/disaster drill was conducted an documented on 5/31/2025.

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.

LPA discussed 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
LPA reviewed PIN 20-24-CCP regarding Safe Sleep with licensee. Licensees stated that he understood.

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 and licensee discussed and reviewed the following: Report suspected child abuse and neglect, form LIC 311D, maintaining children’s records according to regulation, posting required forms. Licensee is reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers and/or similar equipment are not allowed in daycare. Licensee was also provided information regarding SIDS, Lead Exposure and Shaken Baby Syndrome.

See LIC 809C Continuation...

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024
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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: CIBRIAN, ROSA FAMILY CHILD CARE
FACILITY NUMBER: 376624276
VISIT DATE: 05/31/2024
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LPA discussed and provided Licensee with the following: childcare advocates email address: childcareadvocatesprogram@dss.ca.gov. In addition, for general questions or questions regarding licensing requirements contact the Child Care Licensing Duty Line at (619) 767-2248.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed - related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

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.

Per California Code of Regulations, Title 22, Division 12, Chapter 3, deficiencies are being cited. See LIC 809D.



During the exit interview, the Licensee, Rosa Cibrian, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A copy of this report along with Appeals Rights, were provided. A notice of site visit was given 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, Rosa Cibrian and Amy Cibrian who aided as a translator for licensee.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/31/2024 02:19 PM - It Cannot Be Edited


Created By: Vicky Williamson On 05/31/2024 at 12:44 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: CIBRIAN, ROSA FAMILY CHILD CARE
FACILITY NUMBER: 376624276

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/31/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

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 in 1 out of 12 persons in that 15 minute sleep checks were not conducted and documented for Child #1 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/07/2024
Plan of Correction
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Licensee stated that she will submit 15 minute sleep checks for Child #1 to the San Diego Regional Office, no later than 6/7/2024.
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

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 in 1 out of 12 persons in that an Individual Sleeping Plan was not available for review during time of inspection which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/07/2024
Plan of Correction
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Licensee stated that she will submit an Individual Sleeping Plan for Child #1 to the San Diego Regional Office, no later than 6/7/2024.
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:Vicky Williamson
LICENSING EVALUATOR SIGNATURE:
DATE: 05/31/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/31/2024


LIC809 (FAS) - (06/04)
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