<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629302
Report Date: 06/29/2022
Date Signed: 06/29/2022 12:06:32 PM

Document Has Been Signed on 06/29/2022 12:06 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:SOLIS RIVERA, DEMETRIA FAMILY CHILD CAREFACILITY NUMBER:
376629302
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
06/29/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:58 AM
MET WITH:DEMETRIA SOLIS RIVERA TIME COMPLETED:
10:53 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 06/29/22 at 9:58 a.m., Licensing Program Analyst (LPA), Rajani Goudreau conducted an unannounced case management - deficiency inspection. Upon arrival, LPA met with Licensees’ spouse and discussed reason for inspection and proceeded to tour the facility. There were 2 children in care at time of inspection. Facility operates Monday through Sunday, 24 hours a day.

At time of arrival, licensees' spouse was left alone with two day care children without a pediatric CPR/first aid certificate. Licensee and Licensees' daughter arrived at 10:24 a.m. Licensee stated she was running an errand. LPA informed Licensee all individual's caring for the children alone shall obtain a Pediatric CPR/First Aid certificate. Licensee acknowledged understanding of the requirement. Licensee stated her spouse will obtain a Pediatric CPR/First aid certificate.

During today's inspection facility was cited one type B deficiency. LPA provided and discussed the following reports: LIC809, LIC809-D , LIC9213 - Notice of Site Visit and LIC9058 - Appeal Rights. A Notice of Site Visit (LIC 9213) shall to be posted for thirty (30) days from today’s date. Exit interview conducted with Licensee, Demetria Solis Rivera.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Rajani Goudreau
LICENSING EVALUATOR SIGNATURE: DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/29/2022
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 06/29/2022 12:06 PM - It Cannot Be Edited


Created By: Rajani Goudreau On 06/29/2022 at 10:45 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: SOLIS RIVERA, DEMETRIA FAMILY CHILD CARE
FACILITY NUMBER: 376629302

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/29/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/28/2022
Section Cited
CCR
102416(c)

1
2
3
4
5
6
7
102416-Personnel Requirements. (c)-...other personnel as specified shall complete training…pediatric cardiopulmonary resuscitation and pediatric first aid... This requirement was not met as evidence by:
1
2
3
4
5
6
7
Licensee indicated her spouse will obtain a Pediatric CPR/First Aid Certificate and provide a copy of the certificate by July 28, 2022.
8
9
10
11
12
13
14
Based on observation, the licensee did not comply with the section cited above as Licensees' spouse was caring for two children alone without a Pediatric CPR/First Aid certificate, which poses a potential health and safety risk to the children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: 06/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/29/2022


LIC809 (FAS) - (06/04)
Page: 2 of 2