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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628272
Report Date: 06/27/2024
Date Signed: 06/27/2024 02:04:05 PM

Document Has Been Signed on 06/27/2024 02:04 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:PENA, MARIA FAMILY CHILD CAREFACILITY NUMBER:
376628272
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
06/27/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:LIcensee, Maria PenaTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On 06/27/2024 at 12:30 pm, Licensing Program Analyst (LPA), Shannan Williams conducted an unannounced Case Management-licensee initiated inspection with licensee, Maria Pena. LPA Williams informed licensee that the purpose of the inspection was for the requested change of capacity. Licensee led LPA on a tour of the facility. There were five (5) children and one (2) staff members at the facility during the time of the inspection. Hours of operation are Monday through Friday 7:00am – 5:00 pm.

On 06/10/2024 a fire clearance was granted for fourteen (14) children. Licensee will use the following areas for childcare: living room, dining room, bathroom #1, kitchen and backyard. Off Limit areas include: bedroom #1, bedroom #2 bedroom #3, bathroom #2, bathroom #3 . Off limit areas are inaccessible to children by use of safety gates, safety latches or doorknob covers. There is no fireplace on the premises. Licensee utilizes the fenced back yard for outdoor activities. LPA informed licensee to ensure children are supervised at all times during outdoor activities. Licensee stated there are no bodies of water and LPA did not observe any bodies of water during the inspection.
There are sufficient age appropriate toys, games, and play equipment available. The home was clean and orderly during inspection. Detergents, cleaning compounds, and medicines are inaccessible to children in care and poisons are to be locked away. The fire extinguisher is rated 2A:10B:C and located in the kitchen, smoke alarm and carbon monoxide detectors meet requirements and are operational. There is a working cell phone in the home. Licensee stated there are no firearms, other weapons or ammunition on the property.

Licensee maintains documentation of proof of control of property for review by the Department. Property Owner/Landlord Consent form LIC9149 is on file, licensee is property owner and approves to care for eight (14) children. Licensee’s Mandated Reporter AB1207 training and expires on 7/2025. Pediatric CPR and First Aid certifications expire on 04/2026. Immunization records per SB792 were reviewed and met regulations. Required documents are posted.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Shannan Williams
LICENSING EVALUATOR SIGNATURE: DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/27/2024
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
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: PENA, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 376628272
VISIT DATE: 06/27/2024
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All adults living or working in the home have been fingerprint cleared and associated. A total of eight (7) children are currently enrolled. Children's files were reviewed and found complete. The last fire and disaster drill were conducted and documented on 06/12/2024.

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. An Individual Infant Sleeping Plan [LIC 9227 (3/20)] is maintained for each infant up to 12 months of age. The provider places infants up to 12 months of age on their backs for sleeping.

LPA reviewed the following with licensee: SIDS, car seat law, reporting requirements, shaken baby syndrome, care and supervision, and COVID-19 precautions/guidelines. Licensee was also reminded 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 discussed the safe sleep regulations with licensee 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 licensee 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.

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 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.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Shannan Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024
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
SAN DIEGO CC RO, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: PENA, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 376628272
VISIT DATE: 06/27/2024
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Incidental Medical Services (IMS) policy was discussed. 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 reviewed with applicant 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.

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.

The maximum capacity for a Large Family Child Care home: 12 children (with a qualified assistant) with no more than 4 infants; or (with landlord consent) 14 children (with a qualified assistant) with no more than 3 infants, 1 child enrolled in kindergarten or elementary school and 1 child at least age 6 including children under age 10 who live in the licensee's home. When there is no qualified assistant, 14 years of age or present, the capacity reverts to the requirements for a Small Family Child Care.

There were no deficiencies cited during today's inspection.


Increase in capacity was granted on 06/27/2024.

Exit interview conducted and report was reviewed with licensee, Maria Pena. A copy of this report, along with Appeal Rights (LIC9058), were provided. A notice of site visit was given and must remain posted for 30 days. LPA observed that the notice of site visit was posted during the inspection. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Shannan Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024
LIC809 (FAS) - (06/04)
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