<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376624281
Report Date: 04/12/2024
Date Signed: 04/12/2024 04:08:24 PM

Document Has Been Signed on 04/12/2024 04:08 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:VELASCO, IRMA FAMILY CHILD CAREFACILITY NUMBER:
376624281
ADMINISTRATOR/
DIRECTOR:		IRMA VELASCOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 551-8466
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
04/12/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Irma VelascoTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 4/12/2024, at 2:45 p.m., Licensing Program Analyst (LPA), Adrian Castellon conducted an unannounced complaint Inspection and met with licensee Irma Velasco. LPA Castellon disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. Three day-care children were present in the facility during this inspection.

During the inspection, several licensing violations were observed. This LIC809 and LIC809D will be used to document the violations and citations.

Per the licensee, on 4/5/24, child in care C1 fell while in care and chipped a tooth after falling onto wood flooring. Child was taken to the dentist due to the fall. Licensee failed to report the unusual incident/injury.

Licensee states that the facility has been under construction for the past three months as the facility kitchen has been remodeled. Licensee did not advise the regional office as required.

LIC 9227 not in three infant's files as required and discussed during inspection of 12/16/22.

Please see LIC809D for citations. Licensee was provided with a copy of their appeal rights (LIC 9058 03/22) and their signature on this form acknowledges receipt of these rights. 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.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Adrian Castellon
LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2024
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 04/12/2024 04:08 PM - It Cannot Be Edited


Created By: Adrian Castellon On 04/12/2024 at 02:54 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: VELASCO, IRMA FAMILY CHILD CARE
FACILITY NUMBER: 376624281

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/19/2024
Section Cited
CCR
102416.2(b)(1)

1
2
3
4
5
6
7
102416.2 Reporting Requirements (b)(1): (b)The licensee shall report to the Department any of the events as specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C) that occur during the operation of the family child care home.

1
2
3
4
5
6
7
Licensee shall write a declaration acknowledging when and how any unusual incident as discussed in section 102416.2 shall be reported to the licensing office.
8
9
10
11
12
13
14
(1) Medical treatment means treatment by a medical professional, as defined in Section 101152(m). This requirement was not met as evidenced by child in care C1 was injured while in care and received professional medical treatment. Licensee did not report the incident to the regional office. This may pose a threat to the health and safety of children in care.
8
9
10
11
12
13
14
Type B
04/19/2024
Section Cited
CCR102416.3(a)

1
2
3
4
5
6
7
 102416.3 Alterations to Existing Buildings or Grounds:(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following:
1
2
3
4
5
6
7
Licensee shall write a declaration acknowledging that she understands that any alterations to the areas used for day-care purposes in the home must be reported to the licensing office. Licensee will submit a plan detailing how children will be kept out of any dangers concerning the construction.
8
9
10
11
12
13
14
This requirement was not met as evidenced by the licensee failed to inform the licensing office of the facility kitchen being remodeled while children are in care. This may pose a threat to the health and safety of children in care.
8
9
10
11
12
13
14
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:Cynthia Gray
LICENSING EVALUATOR NAME:Adrian Castellon
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2024


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 04/12/2024 04:08 PM - It Cannot Be Edited


Created By: Adrian Castellon On 04/12/2024 at 03:32 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: VELASCO, IRMA FAMILY CHILD CARE
FACILITY NUMBER: 376624281

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/19/2024
Section Cited
CCR
102425(c)(2)

1
2
3
4
5
6
7
102425 Infant Safe Sleep(c)(2): (c) An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 month of age the provider has in care and maintained at the facility in the infant’s file. (2) The Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be
1
2
3
4
5
6
7
Licensee shall submit copies of filled out and signed LIC9227 to the licensing office by the POC date.
8
9
10
11
12
13
14
maintained in the infant’s file and shall be available to the Department for review. This requirement was not evidenced by LIC9227 not kept in three infant's files. this could pose a threat to the health and safety to the children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Cynthia Gray
LICENSING EVALUATOR NAME:Adrian Castellon
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2024


LIC809 (FAS) - (06/04)
Page: 3 of 3