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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629124
Report Date: 11/16/2022
Date Signed: 11/16/2022 04:03:39 PM

Document Has Been Signed on 11/16/2022 04:03 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:PAYANT, VANESSA FAMILY CHILD CAREFACILITY NUMBER:
376629124
ADMINISTRATOR:VANESSA PAYANTFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 617-2037
CITY:LEMON GROVESTATE: CAZIP CODE:
91945
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
11/16/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Vanessa PayantTIME COMPLETED:
04:15 PM
NARRATIVE
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On 11/16/2022 @ 2:05PM, Licensing Program Analyst (LPA) Nancy Diaz arrived at the facility to conduct an unannounced case management inspection. There was no answer at the door. LPA contacted Mrs. Payant via telephone. She stated that she was out picking up children. Mrs. Payant arrived at 2:40PM with 5 children (2 children are her own and the other 3 are siblings). Mrs. Payant stated that some of the children stayed home today.

LPA reviewed all children's files (14 children - two of whom are under age two). LPA also reviewed helper Mireille Dorelus' file. Mrs. Payant stated that Ms. Dorelus started working for her in July of this year.

Mrs. Payant was unable to locate a copy of her lease. She will submit a copy of her lease to the analyst (via email) no later than 11/17/22.

Type B defciencies are cited today. Type B deficiencies if not corrected poses a potential risk to the health, safety or personal rights of children in care.

Exit interview was conducted with Mrs. Payant. A copy of this report and appeal rights were provided today. Notice of site visit was provided and observed posted today.
SUPERVISORS NAME: Renesha Pack
LICENSING EVALUATOR NAME: Nancy Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 11/16/2022 04:03 PM - It Cannot Be Edited


Created By: Nancy Diaz On 11/16/2022 at 03:33 PM
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: PAYANT, VANESSA FAMILY CHILD CARE
FACILITY NUMBER: 376629124

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/16/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/16/2022
Section Cited
CCR
102425

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There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard.

This requirement was not met as evidenced by:
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Mrs. Payant stated that she will obtain another crib or play pen no later than 11/17/2022. She will submit a photo of the crib/play pen and a copy of the receipt no later than 11/17/22.
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Based on observation during a tour of the home, Mrs. Payant has one crib available for napping. She is currently caring for 2 children (ages 17 months and 9 months)
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Type B
11/16/2022
Section Cited
CCR102425(j)(D)

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Documentation shall be maintained in the infant’s file and be available to the Department for review.

This requirement was not met as evidenced by:
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Mrs. Payant stated "moving forward I will maintain the sleep log on file and have available for the Licensing staff to review".
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Based on record review, Mrs. Payant failed to maintain copies of the sleep log for review. She only has sleep log for both infants from September to current month.
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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:Renesha Pack
LICENSING EVALUATOR NAME:Nancy Diaz
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2022


LIC809 (FAS) - (06/04)
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