Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376624066
Report Date: 09/09/2015 12:00:00 AM
Date Signed 09/09/2015 01:36:55 PM

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:FLORES, LENIKA & CESAR FAMILY CHILD CAREFACILITY NUMBER:
376624066
ADMINISTRATOR:LENIKA & CESAR FLORESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 500-5938
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY:14CENSUS: 12DATE:
09/09/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Lenika Flores TIME COMPLETED:
01:45 PM
NARRATIVE
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(3) LPA Celina Damian made an unannounced Annual/Random visit and met with Licensee Lenika FLores . There were 12 children in care, 1 infant and 11 preschool children. There were two aides present as well as a student volunteer. Facility is within ratio and capacity. LPA conducted a tour of the home to ensure compliance with standards established in CCR, Title 22, Division 12, Chapter 3. Licensee is using the following area for daycare; Family room, dining room. living room, kitchen and one bathroom..Off-limits areas include; Three bedrooms, master bathroom and garage.

All cleaners, toxins, medications, poisons and other hazardous substances are inaccessible to children in care and are located in off limits area. Licensee has provided safe toys, play equipment and materials. Home is clean, orderly with adequate heating and ventilation for safety and comfort. Wall heater is non operational. Primary telephone is a land line which is operational. There are no firearms or other weapons in the home. Fire extinguisher, carbon monoxide detector and smoke detector are present in the home and meet State Fire Marshall standards. Licensee has all appropriate forms posted. There are no existing bodies of water present. Outdoor play area is fenced and free of hazardous items. Licensee is currently only using half of the yard and has blocked the other portion of yard. There are no pets at facility. Facility roster is not current and updated. Pediatric CPR and First-Aid certificates are valid through April 2016. Last emergency drill was conducted July 2016. Children’s records were current and two were missing immunization records. Licensee has provided parents or representatives with a copy of the Family Child Care Notification of Parent’s Rights. There are no new adults living or working in the home over the age of 18 years. All adult residents and helpers have submitted or been cleared for criminal record and child abuse index clearances or exemptions.

LPA reviewed the following: required departmental document, supervision, clearances, emergency drills, child passenger law, unusual incidents, mandated reporting, Assembly Bill 633, AB 2084, SIDS, Shaken Baby Syndrome, and Megan's law. Licensee is reminded that corporal punishment, smoking, walkers,
SUPERVISOR'S NAME: Carolina RamosTELEPHONE: (619) 767-2239
LICENSING EVALUATOR NAME: Celina DamianTELEPHONE: 619-767-2200
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2015
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 3


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: FLORES, LENIKA & CESAR FAMILY CHILD CARE
FACILITY NUMBER: 376624066
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2015
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/09/2015
Section Cited
102417(g)(8)
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102417(g)(8) Operation of a Family Child Care Home. All homes shall have a current roster of the children.
Facility does not have a current roster available for review.
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Licensee was provided an LIC 9040. Roster will be updated and a copy will be provided to LPA by 10/09/2015.
Type B
10/09/2015
Section Cited
102418(g)
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102418(g) Immunization. Licensee shall document and maintain each child’s immunizations as long as the child is enrolled.
Two children enrolled did not have required immunization records on file.
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Licensee will properly document children's immunization record as required. Copies of immunization records will be provided by 10/09/2015.
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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: Carolina RamosTELEPHONE: (619) 767-2239
LICENSING EVALUATOR NAME: Celina DamianTELEPHONE: 619-767-2200
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2015
LIC809 (FAS) - (06/04)
Page: 3 of 3


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: FLORES, LENIKA & CESAR FAMILY CHILD CARE
FACILITY NUMBER: 376624066
VISIT DATE: 09/09/2015
NARRATIVE
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exersaucers, jumpers and bouncy seats shall never be permitted during daycare operation. Licensee is aware that they must be present in the home and must ensure that children in care are supervised at all times.

Community Care Licensing WEB SITE: http://www.ccld.ca.gov/ My CCL Web Portal: www.myccl.ca.gov

Please see 809D for deficiencies cited.

SUPERVISOR'S NAME: Carolina RamosTELEPHONE: (619) 767-2239
LICENSING EVALUATOR NAME: Celina DamianTELEPHONE: 619-767-2200
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2015
LIC809 (FAS) - (06/04)
Page: 2 of 3