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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376626229
Report Date: 06/30/2026
Date Signed: 06/30/2026 03:11:43 PM

Document Has Been Signed on 06/30/2026 03:11 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:RIVERA, KARINA FAMILY CHILD CAREFACILITY NUMBER:
376626229
ADMINISTRATOR/
DIRECTOR:		KARINA RIVERAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(858) 208-6141
CITY:SAN DIEGOSTATE: CAZIP CODE:
92111
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 8DATE:
06/30/2026
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Karina RiveraTIME VISIT/
INSPECTION COMPLETED:
03:20 PM
NARRATIVE
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On 06/30/26 at 9:35am, Licensing Program Analyst (LPA) Qwatevyia Edwards and Licensing Program Manager (LPM) Renesha Askew conducted an unannounced annual inspection for a large family child care home (FCCH). LPA identified herself, disclosed the purpose of the inspection, and was granted entry into the home. LPA met with Licensee, Karina Rivera. The Licensee was provided with the Entrance Checklist (LIC 126).

Present in the home were the Licensee, Licensee spouse, Licensee Mom, Assistant/Niece, and Licensee’s own minor two children over the age of 10. The Licensee stated that she has 10 children enrolled in care. During the inspection, there were 8 day care children present, including 4 infants and 4 preschooler. There were two additional infants who left at arrival with a individual identified as their family and caretaker. Per licensee they were not in her care but attending breakfast only while their caretaker was present. Facility was within ratio and capacity during the visit.

The 1 story home was toured and inspected to ensure an environment safe for the care and supervision of children. Licensee has provided adequate space for the children to eat, sleep and play within the home. Areas used for child care include Living room, Family Room, Kitchen, Master Bedroom, Bedroom 3, and main bathroom. Off limits areas include Bedrooms 1 & 2, garage, and master bathroom and are inaccessible through use of child proof gate and doorknob covers. Bedroom 1 & garage were accessible at arrival but licensee corrected this during visit. Licensee stated the doorknob cover fell off of bedroom 1 door and that garage was advised could just be locked. LPA advised that if the lock is accessible to children it makes the garage accessible. (Continued on Page 2)
NAME OF LICENSING PROGRAM MANAGER: Renesha Askew
NAME OF LICENSING PROGRAM ANALYST: Qwatevyia Edwards
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/30/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 06/30/2026 03:11 PM - It Cannot Be Edited


Created By: Qwatevyia Edwards On 06/30/2026 at 12:16 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: RIVERA, KARINA FAMILY CHILD CARE
FACILITY NUMBER: 376626229

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/30/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
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 limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations, the licensee did not comply with the section cited above in that there was Woolite accessible in bedroom 3 which posses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/30/2026
Plan of Correction
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Deficiency was cleared during visit. Licensee removed woolite making it inaccessible. Licensee states she will ensure hazardous items are inaccessible to children at all times.
Type B
Section Cited
CCR
102425(a)(5)
Infant Safe Sleep
(a) There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. (5) Fitted sheets shall be replaced when wet or soiled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations, the licensee did not comply with the section cited above in that all 7 of the playpens available had sheets that were soiled and/or had debris on them. which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/10/2026
Plan of Correction
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Per Licensee she will wash the bedding and provide proof to LPA by due date of 7/10/26. Licensee states moving forward she will not only wash bedding weekly but also ensure to wash as needed when soiled.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Renesha Askew
NAME OF LICENSING PROGRAM MANAGER:
Qwatevyia Edwards
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2026


LIC809 (FAS) - (06/04)
Page: 3 of 16
Document Has Been Signed on 06/30/2026 03:11 PM - It Cannot Be Edited


Created By: Qwatevyia Edwards On 06/30/2026 at 12:16 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: RIVERA, KARINA FAMILY CHILD CARE
FACILITY NUMBER: 376626229

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/30/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in 2 out of 2 infants as there were no sleep logs available for review in the home. Per Licensee she conducts the 15 minute checks. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/10/2026
Plan of Correction
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Per Licensee she will ensure moving forward that the 15 minute checks are completed and documented. She will submit proof of checks to licensing covering the period of July 1-July8 by due date of 7/10/2026
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interview, the licensee did not comply with the section cited above in that licensee last certificate was completed on 8/25/23 which is more than 2 years ago, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/10/2026
Plan of Correction
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Per Licensee she completed the training but could not find the certificate. Licensee states she will email a copy of the certificate or retake course if unable to locate and provide to LPA by due date of 7/10/26.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Renesha Askew
NAME OF LICENSING PROGRAM MANAGER:
Qwatevyia Edwards
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2026


LIC809 (FAS) - (06/04)
Page: 4 of 16
Document Has Been Signed on 06/30/2026 03:11 PM - It Cannot Be Edited


Created By: Qwatevyia Edwards On 06/30/2026 at 12:16 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: RIVERA, KARINA FAMILY CHILD CARE
FACILITY NUMBER: 376626229

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/30/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(m)(3)
Operation of A Family Child Care Home
(3) A file of affidavits signed by each parent with a child enrolled in the home. The affidavit shall state that the parent has been informed that the family child care home does not carry liability insurance or a bond according to standards established by the state.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on file review, the licensee did not comply with the section cited above in 2 (C4 &C8) out of 10 files reviewed did not have LIC 282 on file, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/10/2026
Plan of Correction
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Per Licensee she will have parents complete and submit the form to LPA by due date of 7/10/26. Licensee states moving forward she will ensure that all children files are complete before their first day in care.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Renesha Askew
NAME OF LICENSING PROGRAM MANAGER:
Qwatevyia Edwards
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2026


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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: RIVERA, KARINA FAMILY CHILD CARE
FACILITY NUMBER: 376626229
VISIT DATE: 06/30/2026
NARRATIVE
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The fire extinguisher, smoke detector, and carbon monoxide detector meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. Except bedroom 3 had Woolite accessible, this room is used for napping per licensee. Licensee states that there are no weapons in the home. The fireplace is screened. There is a working phone at the facility, telephone number verified.

The home has a fully fenced backyard available for outdoor activities. Direct visual supervision is advised. There was potting soil accessible which stated “keep out of reach of children” but backyard was not in use at the time. Licensee placed item in inaccessible area prior to taking children outside to play. Per licensee, although there are toys in the front yard it is not used for daycare.

The facility provides clean, safe, and age-appropriate toys for children. Licensee was advised that some of the toys in the backyard are weathered and chipping causing a possible choking hazard if not replaced. A current roster is on file, and required postings, including the Facility Sketch, Emergency Disaster Plan, and Notification of Parent’s Rights, are displayed. Fire and disaster drill documentation is maintained, with the last drill conducted on 03/24/26. Licensee provided LPA with an updated LIC 610A.

LPA reviewed both children’s and staff files and found them to be complete, except two children were missing LIC 282 and sleep logs. Licensee’s First Aid and CPR certifications expire on 07/2027 and Mandated Reporter completed on 08/25/23 and must be updated. Helper’s First Aid and CPR certifications expired on 3/2024 and Mandated Reporter completed on 12/09/24. Licensee and staff meet immunization requirements.


Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA reminded Licensee that all unusual incident reports shall be submitted to Licensing office via email at SDIncidentReports@dss.ca.gov or via fax at (619) 767-2203. Duty officer number is (619) 767-2248.

Continued on Page 3
NAME OF LICENSING PROGRAM MANAGER: Renesha Askew
NAME OF LICENSING PROGRAM ANALYST: Qwatevyia Edwards
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2026
LIC809 (FAS) - (06/04)
Page: 14 of 16
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: RIVERA, KARINA FAMILY CHILD CARE
FACILITY NUMBER: 376626229
VISIT DATE: 06/30/2026
NARRATIVE
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Provider is hereby reminded of the following requirements: report all suspected child abuse and neglect; maintain children’s records in accordance with licensing regulations; and post all required forms and notices. In addition, corporal punishment and smoking are prohibited in the daycare setting. The use of exersaucers, bouncy seats, walkers, and jumpers is also prohibited in daycare. All equipment that is used should be used only as intended by the manufacturer. Licensee states they are registered to receive Provider Information Notices (PINs). LPA discussed and provided Licensee with the following: child care advocates-email address: childcareadvocatesprogram@dss.ca.gov . Licensee has 4 small dogs which are allowed in the daycare care. Licensee states she stores dog food and water bowls in off limits bedroom 1.

The licensee provided proof of control of property. The licensee owns the property.

LPA discussed the 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-andresources/safe-sleep as an additional resource. 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

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.

Continued on Page 4

NAME OF LICENSING PROGRAM MANAGER: Renesha Askew
NAME OF LICENSING PROGRAM ANALYST: Qwatevyia Edwards
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2026
LIC809 (FAS) - (06/04)
Page: 15 of 16
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: RIVERA, KARINA FAMILY CHILD CARE
FACILITY NUMBER: 376626229
VISIT DATE: 06/30/2026
NARRATIVE
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LPA provided Licensee with TSP brochure and advised a TSP referral will be submitted on Licensee’s behalf as a resource.

See LIC809D for Type B deficiencies cited.

Exit interview conducted and report was reviewed with the licensee Karina Rivera.

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

A notice of site visit was given and must remain posted for 30 days.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.
NAME OF LICENSING PROGRAM MANAGER: Renesha Askew
NAME OF LICENSING PROGRAM ANALYST: Qwatevyia Edwards
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2026
LIC809 (FAS) - (06/04)
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