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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376624281
Report Date: 06/20/2024
Date Signed: 06/20/2024 01:08:09 PM

Document Has Been Signed on 06/20/2024 01:08 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: 0DATE:
06/20/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Irma VelascoTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
NARRATIVE
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On 6/20/2024, at 11:45 a.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. No day-care children were present in the facility during this inspection.

During the inspection, LPA issued a citation regarding an incident that occurred on 4/5/24 This LIC809 and LIC809D will be used to document the violation and citation.

Per the licensee, on 4/5/24, child in care C1 fell while in care and chipped a tooth after falling onto wood flooring. Licensee failed to notice the chipped tooth until pointed out by child's representative

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: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2024
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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Document Has Been Signed on 06/20/2024 01:08 PM - It Cannot Be Edited


Created By: Adrian Castellon On 06/20/2024 at 12:36 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: 06/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/28/2024
Section Cited
CCR
102423(a)(2)

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102423 Personal Rights: (a) Each child receiving services from a family child care home shall have certain rights that shall not be waived "... regardless of consent ...from the child's authorized representative". These rights include, but are not limited to, the follow (2) To
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xxx
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 receive safe, healthful, and comfortable accommodations, "...equipment".This requirement was not met as evidenced by licensee Velasco not noticing that child in care chipped a tooth after falling while in care. This may pose a threat to the health and safety of 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:Cynthia Gray
LICENSING EVALUATOR NAME:Adrian Castellon
LICENSING EVALUATOR SIGNATURE:
DATE: 06/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/20/2024


LIC809 (FAS) - (06/04)
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