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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628487
Report Date: 05/08/2024
Date Signed: 05/08/2024 04:36:02 PM

Document Has Been Signed on 05/08/2024 04:36 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/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 7DATE:
05/08/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Anna PortilloTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
NARRATIVE
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On 05/08/24 at 1:45PM, LPAs Luigi Gargaro and Saul Zazueta, conducted an unannounced capacity increase visit with the applicant. Licensee speaks some English but primarily communicates in Spanish. LPA Zazueta provided translation assistance during today's visit. The one story, two bedroom one bath home was toured and inspected to ensure an environment safe for the care and supervision of children. The fire extinguisher and combination smoke and carbon monoxide detector meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. Analyst inquired of the applicant about whether there were any bodies of water or weapons in the home and she replied no.

A review of staff records on this date indicates that most facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. During today's visit, applicant had assistant Sarahi Alvarado-Zorrilla working with her. Ms. Alvarado has criminal record clearances but she was not associated to Ms. Portillo's facility. The home appears to be large enough to comfortably accommodate 14 children. Fire clearance was received on 04/25/24 from the San Diego Fire Department. First Aid and CPR certifications expire in June of 2025.

The following areas used for child care are: the kitchen, the living room, the second bedroom and the bathroom. Off limits areas are the master bedroom and the storage garage. The master 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 applicant has sufficient toys and equipment 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.

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.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE: DATE: 05/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/08/2024
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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Document Has Been Signed on 05/08/2024 04:36 PM - It Cannot Be Edited


Created By: Luigi Gargaro On 05/08/2024 at 02:58 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: 05/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
05/09/2024
Section Cited
CCR
102370(d)(2)

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102370 Criminal Record Clearance (d)(2) - All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: Request a transfer of a criminal record clearance as specified in Section 102370(j)

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Licensee was provided a Criminal Record Clearance Transfer form and completed it during visit. Assistant will have clearances transferred when analyst returns to office.
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Based on analyst record review, licensee assistant Sarahi Alvarado, while having required clearances, did not have them transferred to the licensee's facility which is an immediate 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: 05/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/08/2024


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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: PORTILLO, ANNA FAMILY CHILD CARE
FACILITY NUMBER: 376628487
VISIT DATE: 05/08/2024
NARRATIVE
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 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 and licensee discussed California Megan's Law and he provided licensee with the website address: www.meganslaw.ca.gov for her to review information regarding her facility on a regular basis. Unusual Incident Reports may be e-mailed to: SDIncidentReports@dss.ca.gov.

The following information was reviewed with the applicant: information on reporting requirements for suspected child abuse and unusual incidents, children’s records, immunizations, adults living or working in the home and related civil penalties, shaken baby syndrome, and SIDS. Applicant was reminded that corporal punishment, smoking, walkers, exersaucers, bouncy seats and jumpers are not allowed in day care.

A Type A citation was issued today as licensee's assistant did not have her existing criminal record clearance transferred to the facility, however, she completed a criminal record clearance transfer form during today's visit to correct the deficiency. As licensee received no other citations and was otherwise in compliance, a license for 14 will be issued effective today. Analyst printed a copy of the Notice Of Site Visit today and had licensee place it in her facility notice area before he left the home.

Upon Receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024
LIC809 (FAS) - (06/04)
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