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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629376
Report Date: 10/11/2022
Date Signed: 10/11/2022 01:36:23 PM

Document Has Been Signed on 10/11/2022 01:36 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:SAINT LOUIS, MARIE FAMILY CHILD CAREFACILITY NUMBER:
376629376
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
10/11/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Marie Saint Louis, LicenseeTIME COMPLETED:
01:35 PM
NARRATIVE
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On October 11, 2022 at 10:30 AM, Licensing Program Analyst (LPA), Marie Hernandez and Investigation's Branch (IB) Investigator Willie Vasquez conducted an unannounced Case Management Inspection at the facility for the purpose of health and safety check. LPA and Investigator met with the Licensee, Marie Saint Louis. Present was one day care child and Licensee's two year old child. The Licensee accompanied the LPA and the Investigator of the inspection of the facility. LPA conducted a records review. The Licensee states she has five children enrolled in her facility and that four of the children attend school. The Licensee states she drops off and picks up the children from school . The Licensee states she has not conducted a fire/disaster drill upon enrollment of children in June 2022. The Licensee states she has not obtained the safe sleep plan for the infant and has not documented the fifteen minute checks. The Licensee stated she has not obtained the children's records or their immunization's records.

The following deficiencies were observed and cited on the next page...

An exit interview was conducted and a copy of the report and the appeal rights were discussed and provided to the Licensee Marie Saint Louis. The notice of site visit was provided and posted during the inspection.

SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Marie Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2022
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 10/11/2022 01:36 PM - It Cannot Be Edited


Created By: Marie Hernandez On 10/11/2022 at 11:40 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: SAINT LOUIS, MARIE FAMILY CHILD CARE
FACILITY NUMBER: 376629376

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/11/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/31/2022
Section Cited
CCR
102417(g)(A)

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Operation of A Family Child Care Home -(g) The home shall be free from defects or conditions which might endanger a child...(A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. This requirement is not met as evidenced by:
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The Licensee states she will conduct the fire and disaster drill with the children and will document the drills by 10/31/2022. The Licensee will maintain the fire and disaster drills as per regulations.
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Based on observation, interview and record review, the licensee did not comply with the section cited above in which poses a potential health & safety risk to persons in care. The Licensee stated she has not conducted the fire/disaster drills, once every six months upon enrollment of children of June 2022.
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The appeal rights were discussed and provided.
Type B
10/31/2022
Section Cited
CCR102418(a)

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Immunizations- (a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

This requirement is not met as evidenced by:
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The Licensee will obtain the children's immunization records by 10/31/2022. The Licensee will maintain the children's immunization records as required per regulations.
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Based on observation, interview, record review, the licensee did not comply with the section cited above in which poses a potential health & safety risk to persons in care. The Licensee states she has not obtained the children's immunization records. They were enrolled in June 2022.
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The appeal rights were discussed and provided.
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:Cynthia Gray
LICENSING EVALUATOR NAME:Marie Hernandez
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/11/2022 01:36 PM - It Cannot Be Edited


Created By: Marie Hernandez On 10/11/2022 at 12:04 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: SAINT LOUIS, MARIE FAMILY CHILD CARE
FACILITY NUMBER: 376629376

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/11/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/31/2022
Section Cited
CCR
102421(a)

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Child's Records - (a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).

This requirement is not met as evidenced by:
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The Licensee will complete the children's records by 10/31/2022 and will maintain the children's records at all times.
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Based on observation, interview, record review, the licensee did not comply with the section cited above in which poses a potential health & safety risk to persons in care. The Licensee stated she has not obtained the children's records. There are currently five enrolled in the facility.
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The appeal rights were discussed and provided.
Type B
10/31/2022
Section Cited
CCR102425(c)

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Infant Safe Sleep - (c) An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 month of age...The Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be available to the Department for review. This requirement is not met as evidenced by:
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The Licensee will complete the Infant Safe Sleep Plan for child by 10/31/2022 and will maintain the safe sleep plans at all times for all infants, ages zero through twelve months old at the facility.
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Based on observation, interview, record review, the licensee did not comply with the section cited above in which poses a potential health & safety risk to persons in care. The Licensee stated she has not obtained the infant child's safe sleep plan.
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The appeal rights were discussed and provided.
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:Cynthia Gray
LICENSING EVALUATOR NAME:Marie Hernandez
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2022


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Document Has Been Signed on 10/11/2022 01:36 PM - It Cannot Be Edited


Created By: Marie Hernandez On 10/11/2022 at 12:33 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: SAINT LOUIS, MARIE FAMILY CHILD CARE
FACILITY NUMBER: 376629376

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/11/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/31/2022
Section Cited
CCR
102425(j)(1)(D)

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Infant Safe Sleep - (j) The provider shall supervise infants while they are sleeping and adhere to the following requirements:(1)The provider shall physically check on the infant every 15 minutes. (D)Documentation shall be maintained in the infant’s file and be available to the Department for review. This requirement is not met as evidenced by:
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The Licensee will check on all sleeping infants and will document the sleeping infants every fifteen minutes by 10/31/2022 and will maintain the fifteen minute checks as required per Safe Sleep regulations and will have them available for the Department's review at all times.
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Based on observation, interview, record review, the licensee did not comply with the section cited above in which poses a potential health & safety risk to persons in care. The Licensee stated she has not documented the fifteen minute checks of infant in care.
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The appeal rights were discussed and provided.

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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:Cynthia Gray
LICENSING EVALUATOR NAME:Marie Hernandez
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2022


LIC809 (FAS) - (06/04)
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