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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629058
Report Date: 02/14/2022
Date Signed: 02/14/2022 02:31:57 PM

Document Has Been Signed on 02/14/2022 02:31 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:ESCOBAR, CARMEN FAMILY CHILD CAREFACILITY NUMBER:
376629058
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
02/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH: Carmen Escobar TIME COMPLETED:
12:45 PM
NARRATIVE
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On 02/14/22, at 9:15 a.m., Licensing Program Analyst (LPA), Rajani Goudreau conducted an unannounced Annual Inspection and met with the Licensee, Carmen Escobar. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. Two daycare children and licensee’s minor child were present in the facility during this inspection. Also, this facility is a one story, two-bedroom, one-bathroom house. The following areas are used for childcare: restroom located in hallway of home and daycare room/living room. The following off-limit area is made securely inaccessible: two bedrooms, master bathroom, kitchen, partial of living room, dining room, garage, front yard and back. Operation hours are Monday through Friday from 6:00 a.m. to 4:30 p.m.

The fire extinguisher, smoke detector, and carbon monoxide detector met requirements, per LPA observation. LPA observed the hazardous items inaccessible to children in care. LPA informed licensee poisons shall be placed in a storage area and locked. The fireplace located in the living room is securely screened. LPA observed toys, play equipment and materials available for the children’s use. Licensee utilizes daily walks with the children, if weather permits. LPA informed licensee children shall be supervised during outdoor activities. LPA did not observe any bodies of water on the premises during the inspection. In addition, licensee confirmed there are no bodies of water on the premises of the property. Licensee stated there are no weapons in the home. During the inspection, licensee confirmed two adults have been residing in the attached garage since February 07, 2022. Adults #1 and #2 are uncleared based on file review. There is no access from the home to the garage. The garage entrance is located on the right side of the garage. Licensee stated, she was unaware the adults residing in the garage had to obtain a criminal record clearance. 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. See LIC809
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Rajani Goudreau
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2022
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 02/14/2022 02:31 PM - It Cannot Be Edited


Created By: Rajani Goudreau On 02/14/2022 at 10:48 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
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: ESCOBAR, CARMEN FAMILY CHILD CARE
FACILITY NUMBER: 376629058

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/14/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)
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:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, record review and interview, licensee did not ensure residents #1 and #2 obtained a criminal record clearance prior to residing in the home, which poses an immediate risk to the safety of children in care.



which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/15/2022
Plan of Correction
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Licensee indicated she will obtain a criminal record clearance for resident #1 & 2 today, 02/14/22. Licensee indicated she will provide the LIC9163-Request for Live Scan reflecting completion of live scan to the Department by 02/15/22.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Tulam Vu
LICENSING EVALUATOR NAME:Rajani Goudreau
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/14/2022 02:31 PM - It Cannot Be Edited


Created By: Rajani Goudreau On 02/14/2022 at 11:33 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
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: ESCOBAR, CARMEN FAMILY CHILD CARE
FACILITY NUMBER: 376629058

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/14/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102421(b)

102421 - 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
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Based on record review, the licensee did not comply with the section cited above as two childrens records (Child #1 & #2) were missing all the required licensing forms, including the emergency information card, which poses a potential health, safety or personal rights risk to children in care.
POC Due Date: 03/14/2022
Plan of Correction
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LPA informed licensee of the importance of ensuring children's records are on file at time of starting day care. Licensee acknowledges understanding of the requirement. LPA discussed and provided licensee with the LIC311D - Records To Be Maintained At The Facility-Family Child Care. Licensee indicated she will provide complete children's files for the children currently in care and provide to the Department by: 03/14/22.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Tulam Vu
LICENSING EVALUATOR NAME:Rajani Goudreau
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2022


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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: ESCOBAR, CARMEN FAMILY CHILD CARE
FACILITY NUMBER: 376629058
VISIT DATE: 02/14/2022
NARRATIVE
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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.

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 [facility representative] 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.

LPA 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 . LPA informed licensee in order to sign up for Quarterly Updates and PINs through our website. Please go to www.cdss.ca.gov and on the right side of your screen click on “Receive Important Updates”, put your email address in and choose which program(s) you would like to subscribe to and click “subscribe. In addition, for general questions or questions regarding licensing requirements contact the Child Care Licensing Duty Line at (619) 767-2248.

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. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

See LIC809-C continuation page...
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Rajani Goudreau
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2022
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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: ESCOBAR, CARMEN FAMILY CHILD CARE
FACILITY NUMBER: 376629058
VISIT DATE: 02/14/2022
NARRATIVE
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During today’s inspection, one type A and one type B deficiencies were issued and a civil penalty wa accessed. Exit interview conducted and report was reviewed with the licensee.

LPA, Rajani Goudreau informed licensee that this report dated 02/14/22 document(s) one type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA, Rajani Goudreau informed the licensee to provide a copy of this licensing report dated 02/14/22 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting require

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Rajani Goudreau
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2022
LIC809 (FAS) - (06/04)
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