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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629525
Report Date: 04/17/2024
Date Signed: 04/17/2024 04:51:23 PM

Document Has Been Signed on 04/17/2024 04:51 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:ARREDONDO CERVANTES, MIRIAM FCCFACILITY NUMBER:
376629525
ADMINISTRATOR/
DIRECTOR:		MIRIAM ARREDONDO CERVANTESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 576-6469
CITY:CHULA VISTASTATE: CAZIP CODE:
91915
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
04/17/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:00 PM
MET WITH:Miriam Arredondo, ProviderTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) D. Sanchez was conducting a Complaint inspection. During the review of all adults living and working in this home, staff #1 who is listed on the facility roster is not fingerprint cleared and has been working at the facility for one year. Provider stated that she thought all this time that she was already fingerprint cleared. An immediate civil penalty in the amount of $500.00 is being assessed for allowing an uncleared adult staff working at the facility.

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

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.

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.

NOTICE OF SITE VISIT MUST BE POSTED FOR 30 DAYS
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Diana Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/17/2024
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 04/17/2024 04:51 PM - It Cannot Be Edited


Created By: Diana Sanchez On 04/17/2024 at 03:39 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: ARREDONDO CERVANTES, MIRIAM FCC
FACILITY NUMBER: 376629525

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
04/18/2024
Section Cited
CCR
102395(a)(1)

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Penalties - immediate penalty of $100 per cited violation per day for a maximum of five (5) days shall be assessed...
This requirement was not met as evidenced by:
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Provider Miriam Arredondo stated that she will ensure to remove staff from facility, will ask her to get fingerprint again and wait until she gets cleared to allowed her back to work at the facility. Provider stated she would send proof of the re-printed receipt and a written statement to the San Dieg0 Child Care Regional Office.
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Based on licensee’s admission, and record review, licensee did not comply with the above regulation, as staff has been working at the facility for one year without fingerprint clearance which poses an immediate Health and Safety risk to children in care. Immediate civil penalty of $500.00 is being assessed for an uncleared adult working at the facility.
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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:Diana Sanchez
LICENSING EVALUATOR SIGNATURE:
DATE: 04/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/17/2024


LIC809 (FAS) - (06/04)
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