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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
376100931
Report Date:
10/11/2022
Date Signed:
10/11/2022 03:03:27 PM
Document Has Been Signed on
10/11/2022 03:03 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:
ALCEUS, NERLANDE FAMILY CHILD CARE
FACILITY NUMBER:
376100931
ADMINISTRATOR:
NERLANDE ALCEUS
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(619) 305-4485
CITY:
SAN DIEGO
STATE:
CA
ZIP CODE:
92115
CAPACITY:
14
TOTAL ENROLLED CHILDREN:
14
CENSUS:
7
DATE:
10/11/2022
TYPE OF VISIT:
Annual/Random
UNANNOUNCED
TIME BEGAN:
10:35 AM
MET WITH:
Nerlande Alceus, Provider
TIME COMPLETED:
03:10 PM
NARRATIVE
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On
October 11, 2022
, at 10:35 a.m.
, Licensing Program Analyst (LPA), D. Sanchez, and investigator Zertuche
conducted an unannounced
Annual Required
Inspection and met with the
Licensee, Nerlande Alceus
. Inspection was conducted in Spanish. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee.
Six (6) toddlers, one (1) infant and
one (1)
staff were present in the facility during this inspection. There were three other adults present at the facility at the time of LPA and Investigator arrival. Provider stated that one of the adult was a childcare parent, the other was visiting and the third adult was an adult resident that has been living at the facility since January 2022. This facility is a
single
story, five
bedroom, 3
bathroom
house
. Licensee accompanied LPA inside and out of the facility during this inspection. The following areas used for child care are:
living room, dining room, hallway bathroom, bedroom located next to the master bedroom, kitchen and backyard.
Off limits areas are
master bedroom, the two bedrooms that are located towards the front of the house, backroom located next to the dining room and garage
and are inaccessible through use of door knob protection.
The fire extinguisher, smoke detector, and carbon monoxide detector met requirements. During the inspection LPA found knives in a kitchen drawer. The drawer safety latch was twisted and did not lock. LPA found Clorox and cleaning tablets inside the bathroom drawer accessible to children.
The licensee has toys, play equipment and materials available. The home has a fenced backyard available for outdoor activities. There is a stairs way that leads to the backyard slope and is accessible to children.
Licensee stated there are no weapons in the home.
A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. An adult resident has been living at the facility since January 2022, is fingerprint clear, but not associated to this facility. Licensee’s First Aid and CPR certifications expire on 12/2023
. Licensee has required immunizations. Licensee completed Mandated Reporter Training on
12/02/2021
. Facility children roster was reviewed, but is not current. Five out of the seven dayacare children present during the inspection were not included in the facility roster. The last fire and disaster drills were conducted and documented on 5/10/2022.
SUPERVISORS NAME
:
Jason Garay
LICENSING EVALUATOR NAME
:
Diana Sanchez
LICENSING EVALUATOR SIGNATURE
:
DATE:
10/11/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/11/2022
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
10
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:
ALCEUS, NERLANDE FAMILY CHILD CARE
FACILITY NUMBER:
376100931
VISIT DATE:
10/11/2022
NARRATIVE
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There is one crib or play yard for each infant who is unable to climb out of the crib or play yard.
Cribs or play yards are free from all loose articles and objects.
The provider physically checks on sleeping infants every 15 minutes, but does not document times in the sleeping log.
LPA provided and discussed 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. Licensee was also provided handouts with information regarding upcoming Safe Sleep Regulations/SIDS, Lead exposure and Shaken Baby Syndrome. LPA and Licensee discussed California Megan's Law and LPA provided:
www.meganslaw.ca.gov
.
LPA discussed and provided Licensee with the following: child care advocates email address:
childcareadvocatesprogram@dss.ca.gov
. In addition, for general questions or questions regarding licensing requirements contact the Child Care Licensing Duty Line at (619) 767-2248.
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
.
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.
SUPERVISORS NAME
:
Jason Garay
LICENSING EVALUATOR NAME
:
Diana Sanchez
LICENSING EVALUATOR SIGNATURE
:
DATE:
10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/11/2022
LIC809
(FAS) - (06/04)
Page:
2
of
10
Document Has Been Signed on
10/11/2022 03:03 PM
- It Cannot Be Edited
Created By:
Diana Sanchez
On
10/11/2022
at
01:50 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:
ALCEUS, NERLANDE FAMILY CHILD CARE
FACILITY NUMBER:
376100931
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
10/11/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above in having a knives in kitchen drawer and Clorox and cleaning tabs inside an unsecured bathroom drawer accessible to children, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date:
10/13/2022
Plan of Correction
1
2
3
4
Provider immediately fixed the safety latch of kitchen drawer, but still needs to place a latch or remove all Clorox and cleaning tablets located in the daycare bathroom drawer. Provider shall send pictures of clear drawer to the San Diego Child Care Regional Office as proof of correction.
Type A
Section Cited
CCR
102416.5(e)
Staffing Ratio and Capacity
(e) 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 as specified in subsections (b) and (c).
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above as provider was caring for six toddlers and one infant at one time without assistant, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date:
10/13/2022
Plan of Correction
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2
3
4
Provider shall send a written statement that she read and understood the regulation cited and a written plan to ensure that out of ratio does not happen again.
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:
10/11/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/11/2022
LIC809
(FAS) - (06/04)
Page:
3
of
10
Document Has Been Signed on
10/11/2022 03:03 PM
- It Cannot Be Edited
Created By:
Diana Sanchez
On
10/11/2022
at
01:50 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:
ALCEUS, NERLANDE FAMILY CHILD CARE
FACILITY NUMBER:
376100931
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
10/11/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(3)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (3) Where children are less than five years old are in care, stairs shall be fenced or barricaded.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above, the backyard has an unsecured stairs that leads to the slope and accessible to the children which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
10/14/2022
Plan of Correction
1
2
3
4
Provider shall esure to barricade the backyard stairs. Provider stated that she will ensure to place the baby gate at the bottom of the stais.
Type B
Section Cited
CCR
102370(d)(2)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 102370(j) or
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and record review, the licensee did not comply with the section cited above adult resident has been residing in the facility, is fingerprint cleared but not associated to this facility, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
10/14/2022
Plan of Correction
1
2
3
4
provider stated that she will ensure to transfer the person's fingerprints to this facility by the due date and send proof of correction to the San Diego Child Care Regional Office
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:
10/11/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/11/2022
LIC809
(FAS) - (06/04)
Page:
4
of
10
Document Has Been Signed on
10/11/2022 03:03 PM
- It Cannot Be Edited
Created By:
Diana Sanchez
On
10/11/2022
at
01:50 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:
ALCEUS, NERLANDE FAMILY CHILD CARE
FACILITY NUMBER:
376100931
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
10/11/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102419(b)
Admission Procedures and Authorized Representatives Rights
(b) The licensee shall post the PUB 394 (8/02), Family Child Care Home Notification of Parents’ Rights Poster in a prominent, publicly accessible area in the family child care home at all times children are in care.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above due to provider having the parents poster board located behind coffee table and not visible to parents, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
10/14/2022
Plan of Correction
1
2
3
4
Provider stated that she will place the poster visible to the parents. Provider will send a picture to the San Diego Child Care Regional Office as proof of correction.
Type B
Section Cited
CCR
102419(j)
Admission Procedures and Authorized Representatives Rights
(j) Copies of the signed receipt shall be available to the Department as provided in Section 102391(d).
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and record review, the licensee did not comply with the section cited above facility didn't have children records for five of the children that were present at the facility during the inspection, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
10/14/2022
Plan of Correction
1
2
3
4
Provider stated that four of the children are started daycare today, but she will ensure to do a folder and placed all required documents. Provider shall send copies of each missing child records to the San Diego Child Care Regional Office by the due date of 10/14/2022.
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:
10/11/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/11/2022
LIC809
(FAS) - (06/04)
Page:
5
of
10
Document Has Been Signed on
10/11/2022 03:03 PM
- It Cannot Be Edited
Created By:
Diana Sanchez
On
10/11/2022
at
01:50 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:
ALCEUS, NERLANDE FAMILY CHILD CARE
FACILITY NUMBER:
376100931
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
10/11/2022
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 interview and record review, the licensee did not comply with the section cited above due to provider not having children records available for review which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
10/14/2022
Plan of Correction
1
2
3
4
Provider stated that she will work on the children files and send them to the San Diego Child Care Regional Office as proof of correction.
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 interview and record review, the licensee did not comply with the section cited above due to provider not having children records available for review which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
10/14/2022
Plan of Correction
1
2
3
4
Provider stated that she will work on the children files and send them to the San Diego Child Care Regional Office as proof of correction.
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:
10/11/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/11/2022
LIC809
(FAS) - (06/04)
Page:
6
of
10
Document Has Been Signed on
10/11/2022 03:03 PM
- It Cannot Be Edited
Created By:
Diana Sanchez
On
10/11/2022
at
01:50 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:
ALCEUS, NERLANDE FAMILY CHILD CARE
FACILITY NUMBER:
376100931
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
10/11/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview and record review, the licensee did not comply with the section cited above in provider not having children records available for review, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
10/14/2022
Plan of Correction
1
2
3
4
Provider stated that she will work on the children files and send a copy to the San Diego Child Care Regional Office as proof of correction.
Type B
Section Cited
CCR
102421(a)
Child's Records
(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview and record review, the licensee did not comply with the section cited above in provider not having children records available for review, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
10/14/2022
Plan of Correction
1
2
3
4
Provider stated that she will work on the children files and send a copy to the San Diego Child Care Regional Office as proof of correction.
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:
10/11/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/11/2022
LIC809
(FAS) - (06/04)
Page:
7
of
10
Document Has Been Signed on
10/11/2022 03:03 PM
- It Cannot Be Edited
Created By:
Diana Sanchez
On
10/11/2022
at
01:50 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:
ALCEUS, NERLANDE FAMILY CHILD CARE
FACILITY NUMBER:
376100931
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
10/11/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
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 interview and record review, the licensee did not comply with the section cited above in provider not having children records available for review, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
10/14/2022
Plan of Correction
1
2
3
4
Provider stated that she will ensure to work on all children files and send a copy to the San Diego Child Care Regional Office as proof of correction.
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview and record review, the licensee did not comply with the section cited above by not have an updated facility roster. Five out of the seven children present in the facility were not listed in the roster, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
10/14/2022
Plan of Correction
1
2
3
4
Provider stated that she will send a copy of the updated children roster to the San Diego Child Care Regional Office by the due date of 10/14/2022.
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:
10/11/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/11/2022
LIC809
(FAS) - (06/04)
Page:
8
of
10
Document Has Been Signed on
10/11/2022 03:03 PM
- It Cannot Be Edited
Created By:
Diana Sanchez
On
10/11/2022
at
01:50 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:
ALCEUS, NERLANDE FAMILY CHILD CARE
FACILITY NUMBER:
376100931
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
10/11/2022
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 interview and record review, the licensee did not comply with the section cited above in not having proof that above documents were provided to parents, since there were no children records available to review, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
10/14/2022
Plan of Correction
1
2
3
4
Provider stated she will ensure to obtain the parents signatures on all required documents and send a copy to the San Diego Child Care Regional Office as proof of correction.
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:
10/11/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/11/2022
LIC809
(FAS) - (06/04)
Page:
9
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Document Has Been Signed on
10/11/2022 03:03 PM
- It Cannot Be Edited
Created By:
Diana Sanchez
On
10/11/2022
at
01:50 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:
ALCEUS, NERLANDE FAMILY CHILD CARE
FACILITY NUMBER:
376100931
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
10/11/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview and record review, the licensee did not comply with the section cited above in not having children files available for review which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
10/14/2022
Plan of Correction
1
2
3
4
Provider stated that she will work on the children files and send them to the San Diego Child Care Regional Office as proof of correction.
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:
Jason Garay
LICENSING EVALUATOR NAME:
Diana Sanchez
LICENSING EVALUATOR SIGNATURE:
DATE:
10/11/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/11/2022
LIC809
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