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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376625235
Report Date: 08/24/2023
Date Signed: 09/07/2023 11:08:32 AM

Document Has Been Signed on 09/07/2023 11:08 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:MORAES, ARIANA FAMILY CHILD CAREFACILITY NUMBER:
376625235
ADMINISTRATOR:ARIANA MORAESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 230-5687
CITY:SAN DIEGOSTATE: CAZIP CODE:
92116
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
08/24/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Ariana MoraesTIME COMPLETED:
04:00 PM
NARRATIVE
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On 08/24/23 at 1:35 p.m., Licensing Program Analyst (LPA) Cindy Meier conducted an unannounced case management inspection at the facility. When LPA arrived at the facility, the licensee was not present. There were two (2) assistants (S1) and (S2) present. There were seven (7) children present, six (6) infants, one (1) preschool children. Licensee, Ariana Moraes arrived ten (10) minutes after LPA arrived. LPA met with Licensee, Ariana Moraes.

It was determined that (S1) and (S2) have not obtained a criminal record clearance and required paperwork is not on file. LPA observed (S1) and (S2) leave the facility and informed licensee that they would not be able to return during operating hours until they have received their fingerprint clearances. It was also determined that while licensee was gone from the facility, no one present was CPR and First Aid certified.
LPA reviewed children's files, which were incomplete and missing required documents. Licensee called a parent to pick a child up so licensee was in compliance.

Pursuant to Title 22 of the CA Code of Regulations, the following Type A and B deficiencies were cited (refer to LIC 809-D).

Facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
This is an amended version of the original report created on 08/24/23.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Cindy Meier
LICENSING EVALUATOR SIGNATURE: DATE: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/07/2023
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: MORAES, ARIANA FAMILY CHILD CARE
FACILITY NUMBER: 376625235
VISIT DATE: 08/24/2023
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Per California Code of Regulations, (Title 22, division 12 & Chapter 3) two (2) Type A citations, and three (3) Type B citations are being cited on the attached LIC 809-D.

LPA Cindy Meier informed Licensee, Ariana Moraes that this report dated 8/24/23 document(s) (2) Type A citation(s) which shall be posted for 30 consecutive days as there is immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Cindy Meier informed the Licensee, Ariana Moraes to provide a copy of this licensing report dated 8/24/23 that documents 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.

Exit interview conducted and report was reviewed with licensee, Ariana Moreas. A copy of this report, along with Appeal Rights (LIC9058), were provided. A notice of site visit was given and must remain posted for 30 days. LPA observed that the notice of site visit was posted during the inspection. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Cindy Meier
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/07/2023 11:09 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 08/30/2023 04:41 PM


Created By: Cindy Meier On 08/24/2023 at 01:43 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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: MORAES, ARIANA FAMILY CHILD CARE
FACILITY NUMBER: 376625235

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/24/2023
Section Cited
CCR
102416(d)(1)

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(d) Prior to employment or initial presence in the child care home, all employees and volunteers subject to a criminal record review shall:
(1) Obtain a California clearance or a criminal record exemption as required by law or Department regulations
This requirement is not met as evidenced by:
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Licensee will ensure assistants (S1) and (S2) obtain a criminal record clearance prior to returning to work at the facility.
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Based on observation, interview and record review, the licensee did not comply with the section cited above in that (2) out of (2) persons working/residing in the home did not have a criminal record background clearance which poses an immediate health, safety or personal rights risk to persons in care. Licensee stated assistant (S1) and (S2) began on 8/24/23.

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Type A
08/24/2023
Section Cited
CCR102416.5(d)(1)

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(d)(1) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home...either: (1) no more than four of whom may be infants....
This requirement is not met as evidenced by:
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Licensee stated she will submit a plan of operation for how she will maintain capacity to the SDRO by 8/31/23. Licensee stated she will view the FCCH training video on licensing capacity at CCLD.ca.gov and submit a summary to the SDRO by 8/31/23.
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Based on observation, interview and record review, the licensee did not comply with the section cited above in that two (2) assistants were caring for six (6) infants which poses an immediate health, safety or personal rights risks to persons 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:Jason Garay
LICENSING EVALUATOR NAME:Cindy Meier
LICENSING EVALUATOR SIGNATURE:
DATE: 09/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/07/2023


LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 08/24/2023 07:54 PM - It Cannot Be Edited


Created By: Cindy Meier On 08/24/2023 at 03:12 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: MORAES, ARIANA FAMILY CHILD CARE
FACILITY NUMBER: 376625235

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/24/2023
Section Cited
CCR
102421(b)

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(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required
in Section 102417(g)(7).

This requirement is not met as evidenced by:
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Licensee stated she will submit child record's for all seven (7) children enrolled to the SDRO by 9/7/23.
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Based on observation, interview and record review, the licensee did not comply with the section cited above in that seven (7) out of seven (7) children did not have a completed file for review and were missing required documments which poses a potential health, safety or personal rights risk to persons in care.
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Type B
08/24/2023
Section Cited
CCR102417(g)(8)

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(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
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Licensee stated she will submit a current roster to the SDRO by 9/7/23.
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Based on observation, interview and record review, the licensee did not comply with the section cited above in the licensee did not have a complete roster on file for review which poses a potential health, safety or personal rights risk to persons 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:Jason Garay
LICENSING EVALUATOR NAME:Cindy Meier
LICENSING EVALUATOR SIGNATURE:
DATE: 08/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/24/2023


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 08/24/2023 07:54 PM - It Cannot Be Edited


Created By: Cindy Meier On 08/24/2023 at 03:26 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: MORAES, ARIANA FAMILY CHILD CARE
FACILITY NUMBER: 376625235

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/24/2023
Section Cited
CCR
102416(c)

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(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
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Licensee stated she will ensure that at least one (1) person is certified in EMSA CPR/First Aid at all times during operating hours.
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Based on interview and record review, when the licensee was absent from the facility, assistant (S1) or (S2) do not possess a valid CPR/First Aid card therefore licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons 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:Jason Garay
LICENSING EVALUATOR NAME:Cindy Meier
LICENSING EVALUATOR SIGNATURE:
DATE: 08/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/24/2023


LIC809 (FAS) - (06/04)
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