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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566209716
Report Date: 07/01/2021
Date Signed: 07/01/2021 01:46:26 PM

Document Has Been Signed on 07/01/2021 01:46 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:PITONES FCC AKA GINA'S DAY CAREFACILITY NUMBER:
566209716
ADMINISTRATOR:GEORGINA PITONESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 276-1545
CITY:OXNARDSTATE: CAZIP CODE:
93036
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
07/01/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Georgina PitonesTIME COMPLETED:
02:00 PM
NARRATIVE
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On July 1, 2021 at 11:45 AM Licensing Program Analyst (LPA) Laura Villanueva conducted an unannounced inspection to complete a Case Management-Deficiencies visit. LPA met with Licensee, Georgina Pitones. Due to COVID-19 pandemic, LPA asked the pre screening questions, Licensee's responses indicate no COVID-19 exposure on site. LPA toured home inside and outside with Licensee. The home was organized and safe. The facility is a 5 bedroom 3 bathroom 2 story home.

There were 5 children present upon LPA's arrival, 2 more school aged arrived by bus.The Assistant was with the children. It was nap time, so the children were on mats in the living room. These are 8 children enrolled at the present time. There are 3 dogs present in the home with current immunizations. Licensee had a current roster present. Children record review had immunization records present.

Deficiencies are being cited based on LPA observation, interviews conducted, and record review of facility records on 5/5/2021, When LPA and LPM responded to an incident at the Family Child Care Home involving C1 accordance with the California Code of Regulations, Title 22. See attached LIC809D.

LPA provided and reviewed "What Does Safe Sleep Environment Look Like", PIN 21-19-CCP US Consumer Product Safety Commission Fisher-Price Infant Equipment Recalls, PIN 21-07-CCLD Preparing For Extreme Heat, Public Safety Power Shutoffs, And Wildfire Emergencies, Recently, PIN 20-24-CCP Recently Approved Safe Sleep Regulations In Effect, and Quarterly Update Summer 2021.

An exit interview was conducted and plans of corrections were developed and reviewed with the Licensee. A copy of this report and appeal rights were discussed and left with Licensee, Georgina Pitones, whose signature on this form confirm receipt of these documents. .
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Laura Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 06/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/28/2021
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 07/01/2021 01:46 PM - It Cannot Be Edited


Created By: Laura Villanueva On 06/28/2021 at 11:27 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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: PITONES FCC AKA GINA'S DAY CARE
FACILITY NUMBER: 566209716

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/28/2021
Section Cited
HSC
102425(j)(1)

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102425(j)(1) Infant Safe Sleep (j)The provider shall supervise infants while they are sleeping & adhere to the following requirements:(1) The provider shall physically check on the infant every 15 minutes.
This requirement is not met as evidenced by:
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LPA provided Licensee with brochures of Infant Safe Sleep Regulations in effect
https://www.cdss.ca.gov/Portals/9/CCLD/PINs/2020/CCP/PIN%2020-24-CCP.pdf
Licensee to review and provide a written statement of her understanding of how to monitor a napping infant to the department by close of business 7/2/2021.
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On 05/05/2020, licensee stated she checked on infant #1 every hour & not the required every 15 minutes which poses an immediate Health, Safety or Personal Rights risk to persons in care.
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CCR

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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:George Mingle
LICENSING EVALUATOR NAME:Laura Villanueva
LICENSING EVALUATOR SIGNATURE:
DATE: 07/01/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2021


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/01/2021 01:46 PM - It Cannot Be Edited


Created By: Laura Villanueva On 06/28/2021 at 11:35 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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: PITONES FCC AKA GINA'S DAY CARE
FACILITY NUMBER: 566209716

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/28/2021
Section Cited
CCR
102425(c)(1)(2)

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102425(c)(1)(2) Infant Safe Sleep (c) An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be...12 month of age...included in the infant’s file... (1) This plan shall be signed...(2) The Plan LIC9227 shall be the infant’s file ... This requirement is not met as evidenced by:
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There are no infants in care at this time. Licensee agreed to provide the department with copies of LIC9227 for all infants when they are in care. LPA gave Licensee a copy of LIC9227 for her records.
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Based on review of infant records, an individual infant sleep plan was never completed & signed by the child's authorized representative. For infant #1, #2, #3 & #4 which poses a potential Health, Safety or Personal Rights risk to persons in care.
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Type B
06/28/2021
Section Cited
CCR102425(j)(2)

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102425(j)(2) Infant Safe Sleep(j) The provider... (2)The provider shall check & document the following: (A)Labored breathing.(B)Signs of ...(C1.Infants...sleeping in a position... their back.1.If the infant’s ...LIC 9227 does not have ...infant to their back for sleeping. (D)Documentation shall...
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There are no infants in care at this time. Licensee agreed to provide the department with copies of Infant Safe Sleep Plan when infants are in care.
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This requirement was not met as evidenced by: Based on the child's file review & statements made by the licensee, physical 15-minute checks were not documented which poses a potential 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:George Mingle
LICENSING EVALUATOR NAME:Laura Villanueva
LICENSING EVALUATOR SIGNATURE:
DATE: 07/01/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2021


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/01/2021 01:46 PM - It Cannot Be Edited


Created By: Laura Villanueva On 06/28/2021 at 11:57 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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: PITONES FCC AKA GINA'S DAY CARE
FACILITY NUMBER: 566209716

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/28/2021
Section Cited
CCR
102425(b)

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102425(b) Cribs or play yards shall be free from all loose articles and objects. (b) Cribs or play yards shall be free from all loose articles and objects.

This requirement was not met as evidenced by
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Licensee agrees to submit a written statement of how a crib/playpen must be maintained to the department by close of business 7/2/2021.
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Licensee stated there was a thin blanket in the pack and play when the C1 was napping which poses a potential Health, Safety or Personal Rights risk to persons in care.
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Type B
06/28/2021
Section Cited
CCR102416.2(b)(3)(A)

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102416.2(b)(3)(A) Reporting Requirements The licensee shall report to the Department any of the events as specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C) that occur during the operation of the family child care home. (3) Health and Safety Code Section 1597.467(b)(1) provides in part:
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Licensee to submit a written statement of her understanding of the timelines for Reporting Requirements under Title 22 regulations.
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"A report shall be made to the Department…occurrence of any of the following events: (A) Death of any child from any cause. This requirement was not met as evidenced by: Licensee failed to provide a report of C1’s death. This poses a potential 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:George Mingle
LICENSING EVALUATOR NAME:Laura Villanueva
LICENSING EVALUATOR SIGNATURE:
DATE: 07/01/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2021


LIC809 (FAS) - (06/04)
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