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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376630247
Report Date: 02/12/2025
Date Signed: 02/12/2025 10:17:10 AM

Document Has Been Signed on 02/12/2025 10:17 AM - 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:DOMINIQUE ALEXIS, MARIE FANETTE FCCFACILITY NUMBER:
376630247
ADMINISTRATOR/
DIRECTOR:		MARIE F. DOMINIQUE A.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 373-3906
CITY:SAN DIEGOSTATE: CAZIP CODE:
92105
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
02/12/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Marie Dominique, ProviderTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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On 02/12/2025 at 9:00 am, Licensing Program Analyst (LPA) Diana Sanchez conducted an announced Pre-licensing inspection with provider Marie Dominique in response to the change of location application request. The purpose of the inspection is to ensure the home is in compliance with standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. This single story, three bedrooms, two bath home was toured and inspected. The hours of operation are Monday through Sunday, 6:00 a.m. to 10:00 p.m.

Provider will utilize the following areas for child care: living room, dining room, hallway bathroom and backyard. Off limit areas include: Second floor, kitchen and storage room located in the backyard. Provider will utilize the fenced back and side yard for outdoor activities. LPA informed provider to ensure children are supervised at all times during outdoor activities. Applicant stated there are no bodies of water and LPA did not observe any bodies of water during the inspection.

The fire extinguisher is rated 2A:10BC and is located in the kitchen, smoke and carbon monoxide detectors meet requirements and are operational. Detergents, cleaning compounds, and medicines are inaccessible to children in care and poisons are to be locked away. There is no fireplace on the premises. Children’s toys and play equipment are available. The provider has a working cell phone. Provider stated there are no firearms, other weapons or ammunition in the home.

Provider maintains documentation of proof of control of property for review by the Department. Mandated Reporter AB1207 training expires on 09/2025. Pediatric CPR and First Aid certifications expire on 8/2025. Provider completed 8 hours of preventative health which included nutrition and lead training on 10/24/2023. Immunization records per SB792 were reviewed and met regulations. Required documents are posted.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Diana Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/12/2025
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: DOMINIQUE ALEXIS, MARIE FANETTE FCC
FACILITY NUMBER: 376630247
VISIT DATE: 02/12/2025
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Provider and adult residents in the home have criminal record clearances and/or exemptions on file. Provider was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

LPA advised provider that prior to making alterations or additions to the home or grounds, the provider shall notify the Department of the proposed change. Provider states they are financially secure to operate a family child care home for children and will comply with all regulations and laws governing family child care homes.

Provider does not plan on providing Incidental Medical Services (IMS) to clients at this time. 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.

LPA discussed California Megan's Law and provided licensee the following website: www.meganslaw.ca.gov.

The New Provider Resource Packet was reviewed with the applicant including information on the following: PIN20-24-CCP Safe Sleep Regulations, lead exposure, SIDS, shaken baby, child abuse reporting, community resources, children’s records, facility records, required postings, immunizations, unusual incident report, facility roster, car seat law, visual for ratio/capacity, fire/disaster drill log. Applicant was also informed the following items are prohibited during day care operating hours (walkers, exersaucers, jumpers and bouncy seats). Corporal punishment and smoking are not allowed in the day care. LPA provided applicant PIN22-10-CCP: Updated Guidance For Child Care Providers Regarding Coronavirus Disease (covid-19), along with the COVID Self-Assessment. LPA discussed Guardian with applicant: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian, along with providing PIN 21-02-CCLD Updates to the Implementation of Guardian.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Diana Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025
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: DOMINIQUE ALEXIS, MARIE FANETTE FCC
FACILITY NUMBER: 376630247
VISIT DATE: 02/12/2025
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LPA discussed the safe sleep regulations with provider and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed provider of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPA reviewed with provider the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication. San Diego Regional Office Duty Line was provided: (619) 767-2248.

Southern California Child Care Advocate information was provided, and provider was encouraged to subscribe through the CCLD website in order to be placed on an email list for updated regulation information. Advocate information was provided: (714) 703-2800 or childcareadvocatesprogram@dss.ca.gov.

All requirements for a license have been met. A large license for a maximum capacity of 14 children will be granted effective today 02/12/2025.

LPA Sanchez explained inspection report to provider, provider stated she understood. Exit interview conducted and report was reviewed with the provider, Marie Dominique.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Diana Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025
LIC809 (FAS) - (06/04)
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