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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628487
Report Date: 09/20/2021
Date Signed: 09/20/2021 03:20:31 PM

Document Has Been Signed on 09/20/2021 03:20 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:PORTILLO, ANNA FAMILY CHILD CAREFACILITY NUMBER:
376628487
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 1DATE:
09/20/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Anna PortilloTIME COMPLETED:
03:20 PM
NARRATIVE
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On September 20, 2021, at 12:10PM, Licensing Program Analyst (LPA), Luigi Gargaro conducted an unannounced annual required Inspection and met with the licensee, Anna Portillo. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. Licensee speaks some English but primarily communicates in Spanish. Analyst used Language Link for any needed translation and for the final report. One day care child and Ms. Portillo were present in the facility during the inspection. This facility is a one story, two bedroom, one bathroom home. Licensee accompanied LPA inside and out of the facility during this inspection. The following areas used for child care are: the kitchen, the living room, the master bedroom and the bathroom. Off limits areas are the second bedroom and the storage garage. The second bedroom is made off limits with a door knob cover that is installed on its door handle. The garage is detached from the home and is made further inaccessible with door locks on both entrances.

The fire extinguisher and combination smoke and carbon monoxide detector met requirements. All hazardous items were inaccessible to children. The licensee has toys, play equipment and materials available. The home has a fenced outdoor back patio area available for outdoor activities. The patio contains a storage alley that is made off limits with a slide in gate at its entrance. The licensee is currently not using the patio because she is watching the one non-ambulatory infant. She has made it off limits and maintains a small propane cook stove she uses over the weekends to cook. Licensee understands that the patio cannot be used until she has removed the cook stove and advised analyst of same. The patio is made inaccessible with a locking exit door that leads out from the living room.

No bodies of water observed on the premises during the inspection. Licensee stated there are no weapons in the home. 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. Licensee’s First Aid and CPR certifications expire on May of 2023. Licensee has required immunizations. Licensee does not have current Mandated Reporter Training certification. Facility roster is currently not maintained.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2021
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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Document Has Been Signed on 09/20/2021 03:20 PM - It Cannot Be Edited


Created By: Luigi Gargaro On 09/20/2021 at 01:30 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: PORTILLO, ANNA FAMILY CHILD CARE
FACILITY NUMBER: 376628487

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/20/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/27/2021
Section Cited
CCR
102417(g)(8)

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102417 Operation of a Family Child Care Home (g)(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 was not met as evidenced by:
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Licensee will complete a roster and submit a copy to analyst by 09/27/21. LIcensee understands she must always keep it current with all the children she has in care.
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Based on analyst record review, licensee did not have a copy of the facility roster available for review during today's visit. Not having a facility roster available for review at any given time is a potential risk to children in care.
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Type B
10/25/2021
Section Cited
HSC1596.8662(4)(b)(1)

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1596.8662 Mandated Reporter Training (4)(b)(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider,...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 was not met as evidenced by:
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Licensee will complete the free online training course, in Spanish, at www.mandatedreporterca.com and send analyst a copy of the completion certificate by 10/25/21.
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Based on analyst record review, licensee does not have a current mandated reporter training certificate on file. Not having mandated training is a potential risk to 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:Jason Garay
LICENSING EVALUATOR NAME:Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:
DATE: 09/20/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/20/2021


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/20/2021 03:20 PM - It Cannot Be Edited


Created By: Luigi Gargaro On 09/20/2021 at 02:02 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: PORTILLO, ANNA FAMILY CHILD CARE
FACILITY NUMBER: 376628487

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/20/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/11/2021
Section Cited
CCR
102425(c)

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102425 Infant Safe Sleep (c) An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and maintained at the facility in the infant’s file.The requirement was not met as evidenced by:
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Analyst printed a copy of LIC 9227 form during today's visit for licensee. Licensee states she will give the form to the parent to complete and return and then submit a copy of the completed form to analyst on 10/11/21 as proof of correction of the deficiency.
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Based on analyst observation and record reviews, the licensee did not have a individual Infant Sleeping Plan completed for child #1 a ten month old infant. Not having a documented sleeping plan for an infant in care is a potential risk to their health and safety.
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Type B
10/11/2021
Section Cited
CCR102425(j)(D)

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102425 Infant Safe Sleep (j)(D) The provider shall supervise infants while they are sleeping and adhere to the following requirements: Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: a. Date, b.Infant’s name, c.Time of each 15-minute check.The requirement was not met as evidenced by:
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Licensee stated she will create a sleep tracking document and make entries for the upcoming days infant #1 is attending then submit a copy of the completed chart to that point to analyst on 10/11/21.
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Based on analyst observation and record reviews, the licensee did not have documentation of observation of the napping time for infant #1. Not keeping documentation of an infant's sleep as required by regulation is a potential risk to their health and safety.
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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:Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:
DATE: 09/20/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/20/2021


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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: PORTILLO, ANNA FAMILY CHILD CARE
FACILITY NUMBER: 376628487
VISIT DATE: 09/20/2021
NARRATIVE
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There is one crib or play yard for each infant who is unable to climb out of the crib or play yard. Cribs or play yards are free from all loose articles and objects. The provider has not checked on the sleeping infant every 15 minutes. An Individual Infant Sleeping Plan [LIC 9227 (3/20)] is not maintained for each infant up to 12 months of age. The provider places infants up to 12 months of age on their backs for sleeping.

LPA provided and discussed the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms, and ensure that all adults residing or working in the home have criminal background clearances or exemptions. Licensee was reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers and/or similar equipment are not allowed in daycare. Licensee was also provided handouts with information regarding upcoming Safe Sleep Regulations/SIDS, Lead exposure and Shaken Baby Syndrome. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

LPA discussed and provided Licensee with the following: child care advocates email address: childcareadvocatesprogram@dss.ca.gov . In addition, for general questions or questions regarding licensing requirements contact the Child Care Licensing Duty Line at (619) 767-2248.

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.

Four type B deficiencies California Code of Regulations, (Title 22, Division 12 & Chapter 3), are being cited on the attached LIC 809-D.

An exit interview was conducted with the licensee. 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: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2021
LIC809 (FAS) - (06/04)
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