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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628179
Report Date: 08/06/2021
Date Signed: 08/06/2021 10:58:50 AM

Document Has Been Signed on 08/06/2021 10:58 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:OLOZAGASTE, LIZZETTE FAMILY CHILD CAREFACILITY NUMBER:
376628179
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
08/06/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:28 AM
MET WITH:Lizzette Olozagaste TIME COMPLETED:
11:00 AM
NARRATIVE
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On 8/6/21 at 8:28 am LPA Annette Sutherland conducted an unannounced case management site visit for a capacity increase. This visit is to verify that the licensee remains in substantial compliance with the health & safety standards as required by regulations governing family child care homes. LPA met with licensee and helper Ashley Complido. Licensee has all appropriate forms posted. LPA confirmed with licensee that all adults residing/working in the home have criminal record/TB clearances. Applicant has obtained landlord consent to care for 14 children. The home appears to be large enough to comfortably accommodate 14 children. Fire clearance was received on 4/22/21. First Aid and CPR certifications have expired for licensee . Children’s records were reviewed and found to be in order. Licensee has practiced fire/emergency drills with daycare children according to regulations.

This one story, 4 bedrooms, 2 bathroom home was toured, the following areas are used for daycare: Living room, dining room, kitchen, bathroom, playroom and backyard. Off limit areas include: Bedroom #1, 2, 3 and bathroom #2 and garage. Drawers and lower cabinets in kitchen are either latched or do not contain any hazardous items. There is an operational smoke alarm, carbon monoxide detector and fire extinguisher maintained in the home. There are adequate age appropriate toys, books, games, and napping mats, and hygienic diaper changing equipment. There are no firearms present on the premises as stated by licensee. Furthermore, there are no bodies of water. The outdoor play area is a fully fenced backyard, which is free of hazards and has sufficient toys. Per licensee, operating hours are from 6:00 am - 6:00 pm, Monday thru Friday.

(Continued on 809c......)
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE: DATE: 08/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/06/2021
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: OLOZAGASTE, LIZZETTE FAMILY CHILD CARE
FACILITY NUMBER: 376628179
VISIT DATE: 08/06/2021
NARRATIVE
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LPA reviewed the following: required departmental documents, regulation highlights, community resources, capacity limitations, supervision, clearances, emergency drills, heat-related illness, child passenger law, unusual incidents, mandated reporting, Assembly Bill 633, SIDS, Safe sleep regulations, Shaken Baby Syndrome, Megan's law and Covid information . Applicant is reminded that corporal punishment, smoking, walkers, exersaucers, jumpers and bouncy seats shall never be permitted during daycare operation. Any equipment used should only be used according to the manufacturer recommendations.
For licensing regulations/updates/forms, go to webpage http://www.ccld.ca.gov

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.

Deficiencies are cited. See LIC 809 D for deficiencies cited. A provisional license will be granted when corrections are made.

The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. LPA provided notice of site visit and observed it being posted at the facility.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/06/2021 10:58 AM - It Cannot Be Edited


Created By: Annette Sutherland On 08/06/2021 at 09:54 AM
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: OLOZAGASTE, LIZZETTE FAMILY CHILD CARE
FACILITY NUMBER: 376628179

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/06/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/06/2021
Section Cited
CCR
102416(c)

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102416 Personnel Requirements - (c) The licensee...shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
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Licensee will complete Pediatric First Aid and CPR by (September 1, 2021) and send proof of certificate to LPA Sutherland via e-mail to: Annette.Sutherland@dss.ca.gov. or by text: 619-629-8751. Contact LPA Sutherland if deadline needs extension.
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This requirement was not met as licensee has not renewed CPR/First Aid. Expiration date is 6/2/21. This is a potential health and safety risk to children in care.
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Type B
08/06/2021
Section Cited
CCR102425(j)(2)(d)

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102425 (j)(2)(d) The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.
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Licensee will continue to check and now document infant sleeping progress on sleep logs for infants currently in care and states will keep sleep logs as required for all children under 24 months.
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This requirement was not met as licensee did not have infant sleep log available for review.
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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:Monica Cuddy
LICENSING EVALUATOR NAME:Annette Sutherland
LICENSING EVALUATOR SIGNATURE:
DATE: 08/06/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/06/2021


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