376627917-9-27-2024-51-CC-VHEZ-D9HS3F-20240927133104

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376627917
Report Date: 09/27/2024
Date Signed: 09/27/2024 01:32:22 PM

Document Has Been Signed on 09/27/2024 01:32 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:	PAGAN, NINA FAMILY CHILD CARE		FACILITY NUMBER:	376627917
ADMINISTRATOR/ DIRECTOR:	NINA PAGAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(619) 940-8993
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92120
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 9	DATE:	09/27/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:25 AM
MET WITH:	Nina Pagan		TIME VISIT/ INSPECTION COMPLETED:	02:00 PM

NARRATIVE

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On 9/27/2024 at 11:25 AM, Licensing Program Analyst (LPA) Victoria Hernandez conducted an unannounced Annual inspection. At arrival LPA identified self, disclosed the purpose of the inspection, and was granted entry into the facility by the facility representative, Ann Naibov. At 11:35 AM Licensee Nina Pagan arrived at facility. The one-story home was toured and inspected to ensure an environment safe for the care and supervision of children. Also present, and 9 day care children. Proper supervision and ratios were observed.

Licensee has provided adequate space for the children to eat, sleep and play within the home. Areas used for childcare include: Living Room 2 listed as Daycare Space on sketch, Bathroom 3 and backyard. Off limits areas include: Bedroom 1-3 Bathroom 1-2, Kitchen, Living Room 1 and Garage and are inaccessible through use of gate. The fire extinguisher (size 2A10BC), carbon monoxide detector, and smoke detector meet requirements and are operational and readily accessible. All hazardous items were latched/locked and secured out of reach of children. There is a working phone at the facility. The licensee has sufficient age-appropriate toys and equipment available. The home has a fenced backyard available for outdoor activities. Licensee advised to provide directed supervision when outside. There are no bodies of water on the property. Licensee states that there are no weapons in the home.

Licensee’s First Aid and CPR certifications expire on 7/2026. Helper’s First Aid and CPR certifications expire on 7/2026 . Licensee and staff meet immunization requirements and have completed Mandated Reporter Training on 8/2024, reminded it must be renewed every 2 years. Children and staff records were reviewed and maintained. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. (CONT 809C...)

SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Victoria Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2024

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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: PAGAN, NINA FAMILY CHILD CARE	FACILITY NUMBER: 376627917
	VISIT DATE: 09/27/2024

NARRATIVE

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Licensee was reminded that all adults 18 and over living or working in the home, 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 licensed 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.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 reviewed and/or reminded Licensee of the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, corporal punishment is never allowed. Smoking, exersaucers, bouncy seats, walkers, and jumpers are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer. LPA and Licensee discussed California Megan's Law and LPA provided website: www.meganslaw.ca.gov. LPA reviewed Communicable disease, including Covid-19, guidelines with Licensee and provided resources. LPA discussed the safe sleep regulations with licensee [or facility representative] 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 as an additional resource. LPA also informed licensee [facility representative] 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 directed Licensee to website: https://www.cdss.ca.gov/inforesources/community-care-licensing to receive important updates and information. TSP discussed and brochure provided.

(CONT 809C...)

SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Victoria Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2024

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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: PAGAN, NINA FAMILY CHILD CARE	FACILITY NUMBER: 376627917
	VISIT DATE: 09/27/2024

NARRATIVE

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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.

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.

Exit interview conducted and report was reviewed with the licensee Nina Pagan. During the exit interview, the LICENSEE Nina Pagan, 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.

LPA Victoria Hernandez informed Licensee that this report dated 9/27/24 document 1 Type B citation.

Please see 809D with POC of 10/2/2024

SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Victoria Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/27/2024 01:32 PM - It Cannot Be Edited

Created By: Victoria Hernandez On 09/27/2024 at 12:59 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: PAGAN, NINA FAMILY CHILD CARE	FACILITY NUMBER: 376627917
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/27/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(8)

This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 4 out of 11 children were not listed on roster. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/02/2024
	Plan of Correction
1 2 3 4	The licensee states that she will submit updated roster with all childrens information that were missing forward a copy of the records to LPA via email by POC due date of 10/02/24.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Renesha Askew

LICENSING EVALUATOR NAME:

Victoria Hernandez

LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2024

LIC809 (FAS) - (06/04)

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