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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376611532
Report Date: 12/30/2025
Date Signed: 12/30/2025 05:08:48 PM

Document Has Been Signed on 12/30/2025 05:08 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
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:JIMENEZ, MARIA FAMILY CHILD CAREFACILITY NUMBER:
376611532
ADMINISTRATOR/
DIRECTOR:		JIMENEZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 721-7495
CITY:NATIONAL CITYSTATE: CAZIP CODE:
91950
CAPACITY: 14TOTAL ENROLLED CHILDREN: 7CENSUS: 6DATE:
12/30/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Maria JimenezTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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On 12/30/2025, at 1:30 PAM, Licensing Program Analysts (LPA) Oscar Picazo conducted an unannounced case management incident inspection to follow up on a self reported incident and met with Licensee, Maria Jimenez (S1). Upon arrival, LPA was greeted and granted entry into the facility by Licensee. LPA discussed the purpose of the visit and was led on a tour of the facility indoor and outdoor. There were six (6) day care children, two (2) of which are under 24 months of age. Licensee's adult daughter, Carmen Gaxiola (S2), and adult granddaughter, Arlette Gonzalez (S3), both of who are her assistants were also present during the inspection visit.

On 12/04/2025, Licensee reported an incident regarding a possible lack of supervision involving a day care child, child #1 (C1), where C1 sustained an injury to the forehead that possibly required medical attention. Per the Licensee, the alleged incident occurred on 12/04/2025, at about 8:35 AM, in the day care room.

Interviews were conducted with the Licensee, staff (S2), the alleged child's authorized representative, and attempted day care children, including C1. LPA obtained a copy of the facility roster and picture of the injury sustained. LPA inspected the day care room where the incident occurred to determine that it is safe and age appropriate.

Licensee reported that she, her assistants and 5 children were in the day care room during the time of the incident. Licensee stated that C1 was walking around the crafts table heading toward the cubbies. She states that as she rounded the table, C1's shoe came off causing the child to trip and fall forward. Licensee states that as C1 fell forward, C1 hit thier forehead on the edge of a cubby shelf. Licensee stated that she was sitting at the same crafts table that C1 was rounding during the time of the incident; however although she was on the side of the table where C1 fell, she was not close enough to catch C1 and break the fall.

See Continuation 812C...

NAME OF LICENSING PROGRAM MANAGER: Tulam Vu
NAME OF LICENSING PROGRAM ANALYST: Oscar Picazo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/30/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: JIMENEZ, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 376611532
VISIT DATE: 12/30/2025
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Licensee stated that C1’s authorized representative was contacted immediately and the child was picked up within the hour.

Staff #1 (S1) stated that she was walking into the day care room during the time of the incident and saw when C1 tripped and fell; however the area where C1 fell was at least 6 Feet away from her and she was unable to break C1’s fall.

Of the 5 children present the day of the incident, 2 are infants, 2 are absent and not present during this visit and C1 did not want to speak with the LPA so the interview was terminated.

Based on staff and day care children interviews it was determined that the child care room is safe, age appropriate and there was appropriate staff supervision in the room during the time of the incident and therefore the incident is determined to be an accident.

NAME OF LICENSING PROGRAM MANAGER: Tulam Vu
NAME OF LICENSING PROGRAM ANALYST: Oscar Picazo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
LIC809 (FAS) - (06/04)
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