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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628272
Report Date: 12/21/2021
Date Signed: 12/21/2021 10:47:54 AM

Document Has Been Signed on 12/21/2021 10:47 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:PENA, MARIA FAMILY CHILD CAREFACILITY NUMBER:
376628272
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
12/21/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Maria Pena, LicenseeTIME COMPLETED:
11:05 AM
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On 12/21/2021 at 9:50 a.m., Licensing Program Analyst (LPA), Michelle Hood conducted an unannounced Annual Required Inspection and met with the Licensee. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. There were no children present in the facility during this inspection. The licensee accompanied LPA inside and out of the facility during this inspection. The following areas used for child care are the living room, dining room, kitchen, downstairs bathroom, and patio. The off-limits areas are inaccessible through the use of a safety gate at the bottom of the stairs.

The fire extinguisher, smoke detector, and carbon monoxide detector met the requirements. All hazardous items were inaccessible to children. The licensee has toys, play equipment, and materials available. No bodies of water were observed on the premises during the inspection. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to the 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. Licensee’s First Aid and CPR certifications expire on 07/2023. The licensee has required immunizations. The licensee stated there's been no children enrolled at her daycare since she was licensed.

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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Michelle Hood
LICENSING EVALUATOR SIGNATURE: DATE: 12/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/21/2021
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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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: PENA, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 376628272
VISIT DATE: 12/21/2021
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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.

LPA provided and discussed the following: Report suspected child abuse and neglect, maintain children’s records according to regulation, and post all required forms. The licensee was reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers, and/or similar equipment are not allowed in daycare. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov.

No deficiencies cited

An exit interview was conducted and the report was reviewed with the licensee Maria Pena. 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.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Michelle Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2021
LIC809 (FAS) - (06/04)
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