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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629230
Report Date: 11/17/2022
Date Signed: 11/17/2022 02:41:19 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 11/17/2022 02:41 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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:MAGNY, NANCY FAMILY CHILD CAREFACILITY NUMBER:
376629230
ADMINISTRATOR:NANCY MAGNYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 581-0959
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
11/17/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Nancy Magny, LicenseeTIME COMPLETED:
03:00 PM
NARRATIVE
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On 11/17/2022 at 1:50 pm, Licensing Program Analyst (LPA), Michelle Hood conducted an unannounced Case Management - Annual Continuation Inspection and met with Licensee Nancy Magny. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. There were no daycare children present in the facility during this inspection; however, the licensees three children were present. Per the licensee the operating hours are Sunday through Saturday 7:30 am to 9:30 pm.

On 10/11/2022, during an attempted inspection the licensee informed LPA Selina Siao that Marie Kettia Jambom and Wadmaer Victorin have been residing at the home for eight to ten months.

On 11/10/2022 during a Required 1-year inspection the licensee informed LPA Hood that Jambom and Victorin were residing at the home, but recently moved out. Jambom and Victorin were fingerprinted; however, they have an invalid fingerprint status and not associated to the facility. The last LIC 279 - Application for a Family Child Care Home License in the facility file is dated 11/07/2021 and does not reflect Jambom and Victorin.

LPA Hood informed licensee Nancy Magny that this report dated 11/17/2022 document Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. Also, LPA Hood informed the licensee Nancy Mangy to provide a copy of this licensing report dated 11/17/2022 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview was conducted and the report was reviewed with the licensee Nancy Magny. See the LIC 809D.
Language Link agent #15517 translated in Haitian Creole.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Michelle Hood
LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2022
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 11/17/2022 02:41 PM - It Cannot Be Edited


Created By: Michelle Hood On 11/17/2022 at 01:17 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: MAGNY, NANCY FAMILY CHILD CARE
FACILITY NUMBER: 376629230

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/17/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/18/2022
Section Cited
CCR
102370(d)(1)

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102370(d)(1) 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: (1) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement is not met as evidenced by:
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The licensee provided the LPA a written declaration on the LIC 855 form, stating Wadmaer Victorin and Marie Kettia Jambom no longer reside in the home. Also, the licensee stated she understands all adults must be fingerprint cleared and associated before residing in the home. The Language Link agent #15517
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Based on the licensees admittance and LPA Siao's observation, the licensee did not comply with the section cited above the facility did not ensure all adults were fingerprint cleared and associated before allowing the uncleared adults to move in the home, which poses an immediately health, safety or personal rights risk to persons 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:Cynthia Gray
LICENSING EVALUATOR NAME:Michelle Hood
LICENSING EVALUATOR SIGNATURE:
DATE: 11/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/17/2022


LIC809 (FAS) - (06/04)
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