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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629559
Report Date: 03/04/2025
Date Signed: 03/04/2025 04:34:52 PM

Document Has Been Signed on 03/04/2025 04:34 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:RODRIGUEZ PEREZ, MERCEDES FAMILY CHILD CAREFACILITY NUMBER:
376629559
ADMINISTRATOR/
DIRECTOR:		MERCEDES RODRIGUEZ PEREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 955-9747
CITY:SAN DIEGOSTATE: CAZIP CODE:
92139
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 1DATE:
03/04/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Mercedes Rodriguez PerezTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
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On March 4, 2025, at 2:00 p.m. Licensing Program Analyst (LPA) Cindy Meier conducted a case management inspection at the facility. Upon arrival, LPA met with Licensee, Mercedes Rodriguez Perez and advised the licensee of the purpose of the inspection and was led on a tour of the facility. Licensee and one (1) child was present during the inspection. The LPA used Focus Language during the inspection which provided translation for the licensee.

Based on interview and records reviewed, it was also determined that the licensee did not report the incidents on June 20, 2024 and on December 17, 2024 to the Department as required.

Per California Code of Regulations, (Title 22, division 12 & Chapter 1) one (1) Type B citation is being cited on the attached LIC 809-D.



Exit interview conducted and report was reviewed with Licensee, Mercedes Rodriguez Perez.
A copy of this report, along with Appeal Rights (LIC9058 03/22), were provided.
A Notice of Site Visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Cindy Meier
LICENSING EVALUATOR SIGNATURE: DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2025
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 03/04/2025 04:34 PM - It Cannot Be Edited


Created By: Cindy Meier On 03/04/2025 at 08:17 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: RODRIGUEZ PEREZ, MERCEDES FAMILY CHILD CARE
FACILITY NUMBER: 376629559

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/04/2025
Section Cited
CCR
102416.2(b)

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102416.2(b) Reporting Requirements (b) The licensee shall report to the Department any of the events as specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C) that occur during the operation of the family childcare home.

This requirement was not met as evidenced by:
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Licensee stated she will review the training video on Child Care Reporting Requirements on https://ccld.childcarevideos.org/family-child-care-providers/ and provide a written summary of what she learned to San Diego Regional Office by 03/18/25.
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Based on interviews conducted and records reviewed, the licensee did not comply with the above regulation, as the licensee did not report incidents that occurred at the facility which required a daycare child to seek medical treatment to the Department which poses a potential Health & Safety risk to children in care.
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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:Jason Garay
LICENSING EVALUATOR NAME:Cindy Meier
LICENSING EVALUATOR SIGNATURE:
DATE: 03/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/04/2025


LIC809 (FAS) - (06/04)
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