Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376624066
Report Date: 01/26/2017
Date Signed 01/26/2017 02:51:37 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 FAMILY CHILD CAREFACILITY NUMBER:
376624066
ADMINISTRATOR:FLORES, LENIKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 426-1513
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY:14CENSUS: 12DATE:
01/26/2017
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Lenika FloresTIME COMPLETED:
03:00 PM
NARRATIVE
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LPA Damian conducted an unannounced POC visit on this date. Upon arrival LPA met with Licensee Flores. Assistant was also present. There were 12 children present during visit. Children were napping during visit. The purpose of the visit is to follow up on deficiencies cited during 11/15/2016 Annual/Random Visit. During that visit the following deficiencies were cited:
  • All individuals subject to a criminal record review as specified in Section 1596.871 prior to working, residing or volunteering in a licensed home, shall obtain a California clearance. An assistant working did not have required fingerprint clearance. All individuals working in the facility have obtained proper fingerprint clearances.
  • Home" means the licensee's residence as defined by Government Code Section 244. Licensee Karina Hernandez moved out of home eight months ago. Department was not notified. Karina Hernandez was removed from license and updated license was issued.
  • The license shall be available in the facility upon request. License is not posted and is not available. Updated license was posted today.
  • A person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Licensees, assistants and student volunteer does not have required pertussis, measles immunization and flu vaccine or exemption as required. Licensee and one assistant have not provided proof of all required immunizations. A recitation will be issued.

Additionally licensee has not provided parents or guardians with LIC 9224 as required. A Type B deficiency will be issued. Please see 809D. Appeal rights provided and Notice of Site Visit posted during visit.
SUPERVISOR'S NAME: Carolina RamosTELEPHONE: (619) 767-2206
LICENSING EVALUATOR NAME: Celina DamianTELEPHONE: 619-767-2200
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2017
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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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 FAMILY CHILD CARE
FACILITY NUMBER: 376624066
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/26/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/03/2017
Section Cited
H&S 1596.8595
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A licensed child care home shall provide to the parents of each child receiving services in the facility copies of any licensing report that documents any Type A citation.
Licensee has not provided parents with reports citing a Type A deficiency from 11/15/2016 Visit.
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Licensee states she was waiting on appeal response prior to providing reports. Licensee will provide parents a copy of report dated 11/15/2016 and will obtain signatures on LIC 9224. Copies of LIC 9224 will be provided to LPA by 02/03/2017.
Type B
02/03/2017
Section Cited
H&S 1597.622
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A person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Licensees, assistants and student volunteer does not have required pertussis, measles immunization and flu vaccine or exemption as required. Licensee and one assistant have
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Licensee will obtain proof of flu shot and assistant will obtain proof of all three immunizations. Copies will be provided by 02/03/2017.
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not obtained proof of immunizations as required.
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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) 767-2206
LICENSING EVALUATOR NAME: Celina DamianTELEPHONE: 619-767-2200
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2017
LIC809 (FAS) - (06/04)
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