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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629091
Report Date: 11/02/2022
Date Signed: 11/02/2022 01:48:27 PM

Document Has Been Signed on 11/02/2022 01:48 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:GRIJALVA, MARICELA FAMILY CHILD CAREFACILITY NUMBER:
376629091
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
11/02/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:MARICELA GRIJALVATIME COMPLETED:
02:00 PM
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On 11/02/2022 at 10:25 a.m., Licensing Program Analyst (LPA) Claudia Amador conducted an unannounced Case Management- licensee initiated inspection with the Licensee, Maricela Grijalva and her spouse Ernest Grijalva. LPA Amador informed the Licensee that the purpose of the inspection was for the requested change of capacity. The Licensee led LPA on a tour of the facility. Two children (eight and four years old) were present. One (1) staff member with all required forms was at the facility during the inspection. Hours of operation are Monday through Sunday, 12:00 a.m. – 11:59 p.m.

On 10/10/2022, a fire clearance was granted for fourteen (14) children. The Licensee will use the following areas for childcare: living room, dining room, family room, kitchen, bathroom, and backyard. Off Limit areas include second-floor bedrooms(x3) and bathrooms (x2). Off-limit areas are inaccessible to children through safety gates, safety latches, or doorknob covers. The fireplace is located in the living room and one in the family room and securely screened and locked.
The Licensee utilizes the fenced backyard for outdoor activities.
LPA informed the Licensee to ensure children are supervised at all times during outdoor activities. The Licensee stated there were 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 the inspection. Detergents, cleaning compounds, and medicines are inaccessible to children in care, and poisons are to be locked away. The fire extinguisher is rated 3A:40B: C and is located in the kitchen. Smoke alarms and carbon monoxide detectors meet requirements and are operational. There is a working cell phone in the home.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Claudia Amador
LICENSING EVALUATOR SIGNATURE: DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/02/2022
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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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: GRIJALVA, MARICELA FAMILY CHILD CARE
FACILITY NUMBER: 376629091
VISIT DATE: 11/02/2022
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The Licensee stated there were no firearms, other weapons, or ammunition on the property.

The Licensee maintains documentation of proof of control of the property for review by the Department.
The Licensee's Mandated Reporter AB1207 training expires on 03/2023. Pediatric CPR and First Aid certifications expire on 10/2024. Immunization records per SB792 were reviewed and met regulations. Required documents are posted.

All adults living or working in the home have been fingerprint cleared and associated. The facility roster was available and updated. A total of eight (8) children are currently enrolled. Children's files were reviewed and found complete. The last fire and disaster drill were conducted and documented on 5/11/2022.


LPA reviewed the following with the Licensee: SIDS, car seat law, reporting requirements, shaken baby syndrome, care and supervision, and COVID-19 precautions/guidelines. The Licensee was also reminded the following items are prohibited during daycare operating hours (walkers, exersaucers, jumpers, and bouncy seats). Corporal punishment and smoking are not allowed in the daycare.

LPA discussed the safe sleep regulations with the Licensee and 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 the 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 registering all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

The 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.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Claudia Amador
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
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: GRIJALVA, MARICELA FAMILY CHILD CARE
FACILITY NUMBER: 376629091
VISIT DATE: 11/02/2022
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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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA reviewed with the 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. Report unusual incidents, call within 24 hours of the incident and provide the LIC 624/UIR within 7 days.

The maximum capacity for a Large Family Child Care home is: 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 no qualified assistants are 14 years of age or older present, the capacity reverts to the requirements for a Small Family Child Care.

No deficiencies were cited during today's inspection.

An increase in capacity was granted on this date.

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.

Exit interview conducted and report reviewed with Licensee Maricela Grijalva. 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.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Claudia Amador
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
LIC809 (FAS) - (06/04)
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