376629497-5-8-2023-20-CC-JARL-CRMRUG-20230508131951

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376629497
Report Date: 05/08/2023
Date Signed: 05/08/2023 01:20:22 PM

Document Has Been Signed on 05/08/2023 01:20 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:	JUAREZ, ROSA FAMILY CHILD CARE		FACILITY NUMBER:	376629497
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	05/08/2023
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:25 AM
MET WITH:	Rosa Juarez		TIME COMPLETED:	01:10 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On May 8^th, 2023, at 11:25 AM, Licensing Program Analyst (LPA) Jo Ann Legaspi conducted an unannounced Annual Inspection and met with the Licensee Rosa Juarez. LPA disclosed the purpose of the inspection and was granted facility entry by the Licensee. No daycare children were present in the daycare. Licensee shares her home with one (1) small dog. Only the Licensee and two (2) adult relatives, who are background cleared, were present in the facility during this inspection. Language Link Operators 14962 and 15964 provided Spanish translation services. This facility is a (5) bedroom, three (3) bathroom, two (2) story house. The following areas used for childcare are: the living room, family room, enclosed patio room, one (1) bathroom, fenced backyard and fenced front yard. The off limits areas include the kitchen, remaining bathrooms, and bedrooms. Kitchen cabinets have sliding cabinet locks. The stairs to the bedrooms and remaining bathrooms are gated with a retractable child safety gate. The fire extinguisher, smoke detector, and carbon monoxide detector met requirements. Hazardous items were observed inaccessible to children during this inspection. The Licensee has available toys, play equipment and materials. Licensee states children play in the fenced front yard and fenced backyard. Licensee was reminded that continuous supervision is to be given to children whenever engaged in outdoor activities. No bodies of water were observed on the premises during the inspection. Licensee stated there are no weapons in the home. Licensee’s First Aid and CPR certifications expire in May 2024. Licensee has required immunizations. Mandated Reporter Training was completed on 05/08/2022. The facility roster is maintained and was reviewed. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 5

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: JUAREZ, ROSA FAMILY CHILD CARE	FACILITY NUMBER: 376629497
	VISIT DATE: 05/08/2023

NARRATIVE

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LPA reminded Licensee of 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.

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 were observed as per California Code of Regulations, (Title 22, Division 12 & Chapter 3), and are being cited on the attached LIC 809-D.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the Licensee Rosa Juarez.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2023

LIC809 (FAS) - (06/04)

Page: 4 of 5

Document Has Been Signed on 05/08/2023 01:20 PM - It Cannot Be Edited

Created By: JoAnn R Legaspi On 05/08/2023 at 11:49 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: JUAREZ, ROSA FAMILY CHILD CARE	FACILITY NUMBER: 376629497
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/08/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102418(a)

Immunizations

(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, record reviews and Licensee's statement, , the licensee did not comply with the section cited above in that 1 out of 4 children did not have their immunization records on file, which poses as a potential health, safety or personal rights risk to children in care.
	POC Due Date: 05/19/2023
	Plan of Correction
1 2 3 4	LPA provided Licensee with the LIC 311D and an informational packet which shows all the forms that need to be on file in the daycare. Licensee states that she will ensure that all enrolled children have a complete daycare file. Licensee agrees to provide LPA with a written statement describing how she will ensure all enrolled daycare children have their own individual complete daycare file.

Type B

Section Cited

CCR

102421(b)

Child's Records

(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 is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, Licensee's statement and record reviews, the licensee did not comply with the section cited above in that 1 out of 4 children did not have a copy of their emergency information card or an individual daycare file, which poses as a potential risk to the health, safety or personal rights risk to children in care.
	POC Due Date: 05/19/2023
	Plan of Correction
1 2 3 4	LPA provided Licensee with the LIC 311D and an informational packet which shows all the forms that need to be on file in the daycare. Licensee states that she will ensure that all enrolled children have a complete daycare file. Licensee agrees to provide LPA with a written statement describing how she will ensure all enrolled daycare children have their own individual complete daycare file.

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:

JoAnn R Legaspi

LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2023

LIC809 (FAS) - (06/04)

Page: 3 of 5

Document Has Been Signed on 05/08/2023 01:20 PM - It Cannot Be Edited

Created By: JoAnn R Legaspi On 05/08/2023 at 11:49 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: JUAREZ, ROSA FAMILY CHILD CARE	FACILITY NUMBER: 376629497
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/08/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(7)

Operation of A Family Child Care Home

(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, Licensee's statement and record reviews, the licensee did not comply with the section cited above in that 1 out of 4 children did not have an emergency information card, which poses as a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/19/2023
	Plan of Correction
1 2 3 4	LPA provided Licensee with the LIC 311D and an informational packet which shows all the forms that need to be on file in the daycare. Licensee states that she will ensure that all enrolled children have a complete daycare file. Licensee agrees to provide LPA with a written statement describing how she will ensure all enrolled daycare children have their own individual complete daycare file.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

JoAnn R Legaspi

LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2023

LIC809 (FAS) - (06/04)

Page: 5 of 5

Document Has Been Signed on 05/08/2023 01:20 PM - It Cannot Be Edited

Created By: JoAnn R Legaspi On 05/08/2023 at 11:49 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: JUAREZ, ROSA FAMILY CHILD CARE	FACILITY NUMBER: 376629497
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/08/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102419(d)(1)

Admission Procedures and Authorized Representatives Rights

(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05). (1) The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or authorized representative has received and read the LIC 995A. The bottom portion of this form must be kept in the child’s file as proof that the parent or authorized representative has been notified of his or her rights and received a copy of the Caregiver background Check Process, LIC 995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, Licensee's statement and record reviews, the licensee did not comply with the section cited above in that 1 out of 4 children lacked a LIC 995A signed by their parent, which poses as a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/19/2023
	Plan of Correction
1 2 3 4	LPA provided Licensee with the LIC 311D and an informational packet which shows all the forms that need to be on file in the daycare. Licensee states that she will ensure that all enrolled children have a complete daycare file. Licensee agrees to provide LPA with a written statement describing how she will ensure all enrolled daycare children have their own individual complete daycare file.

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:

JoAnn R Legaspi

LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2023

LIC809 (FAS) - (06/04)

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