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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629265
Report Date: 12/06/2022
Date Signed: 12/06/2022 12:33:47 PM

Document Has Been Signed on 12/06/2022 12:33 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:KAROLI, ERICK FAMILY CHILD CAREFACILITY NUMBER:
376629265
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
12/06/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Erick Karoli TIME COMPLETED:
12:01 PM
NARRATIVE
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On 12/06/2022 at 9:10am, Licensing Program Analysts (LPAs) David Miller and Michelle Hood conducted an unannounced case management inspection for the purpose of a capacity increase from a small to a large license. LPA met with the licensee, Erick Karoli. No children were present.

On 09/09/2022, Licensee submitted an application (LIC 279) requesting a capacity increase. The Fire Safety Inspection Request (STD 850) was approved for fourteen (14) children on 10/21/2022.

This facility is a one story, four (4) bedroom, two (2) bathroom home. Licensee accompanied LPA during this inspection. Licensee is using the following areas for daycare: daycare room, dining room, kitchen, and bathroom. Licensee stated that the daycare room will be used for isolation of sick children. Off limits areas include; all four bedrooms and bathroom #2, and are made inaccessible via a safety locks on all the doorknobs. Licensee states he will utilize fenced backyard for outdoor activities. Licensee was reminded that continuous supervision is to be given to children whenever engaged in outdoor activities. The hours of operation are Monday through Friday from 6:00am to 11:59pm. Licensee stated he will notify the Department of any changes in the hours of operation.

The fire extinguisher is rated 2A 10B: C. and is in the kitchen mounted on the kitchen wall. The smoke/carbon monoxide detector meets requirements and is operational. LPA observed that the home has sufficient space, toys, and equipment available for children’s use.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: David Miller
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2022
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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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: KAROLI, ERICK FAMILY CHILD CARE
FACILITY NUMBER: 376629265
VISIT DATE: 12/06/2022
NARRATIVE
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Licensee’s First Aid and CPR certifications expire on 03/19/2022. Licensee has required immunizations. Licensee completed the mandated reporter training on 09/16/2022. The facility roster is maintained and was reviewed. Licensee stated there are no bodies of water on the premises, and no weapons or ammunition in the facility. LPA observed no bodies of water during the inspection.

The Licensee was provided with the Ratio/Capacity Worksheet for a large family childcare home. The Licensee acknowledged that if no assistant provider is present at a Large Family Child Care Home, then the Licensee shall comply with the capacity requirements for a Small Family Child Care Home. Licensee stated that has property owner landlord consent (LIC-9149) to care for 14 children.

The Licensee is advised to regularly visit the Community Care Licensing WEB SITE: http://www.ccld.ca.gov/ for quarterly updates and updated regulation information. Duty Line was provided: (619) 767-2248. Southern California Child Care Advocate (SCCCA) information was provided. The Licensee is already enrolled in this program’s email
email list through the CCLD website, thus receives updated regulation information. Advocate information was provided: (916) 654-1541 and childcareadvocatesprogram@dss.ca.gov

During a file review, the following deficiencies were noted. Please see LIC 809-D

Due to printer technical errors, LPA was unable to print out the licensee report and Notice of Site Visit, and the licensee shall reply within 24 hours. A notice of site visit was given and must remain posted for 30 days. Failure to comply with this posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the Licensee Erik Karoli.

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: David Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/06/2022 12:33 PM - It Cannot Be Edited


Created By: David Miller On 12/06/2022 at 11:11 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: KAROLI, ERICK FAMILY CHILD CARE
FACILITY NUMBER: 376629265

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/06/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/16/2022
Section Cited
CCR
102421

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102421(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required in Section 102417(g)(7).

This requirement was not met as evidenced by:
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LIcensee stated that he will submit all forms to ensure he has all required documents for childrens' records, and submit these by 12/16/2022
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Based on interviews and record review, licensee did not comply with the above regulation as licensee allowed children to attend the facility without having child records, which poses a potential health and safety 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:Tulam Vu
LICENSING EVALUATOR NAME:David Miller
LICENSING EVALUATOR SIGNATURE:
DATE: 12/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/06/2022


LIC809 (FAS) - (06/04)
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