Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376624202
Report Date: 01/29/2018
Date Signed 01/29/2018 10:18:35 AM

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:HIBBERT, BARBARA FAMILY CHILD CAREFACILITY NUMBER:
376624202
ADMINISTRATOR:BARBARA HIBBERTFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 761-9982
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY:14CENSUS: 5DATE:
01/29/2018
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Barbara HibbertTIME COMPLETED:
10:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Iman Al-Absi conducted a Proof of Correction (POC) inspection on this date. Upon arrival, LPA met with Licensee Barbara Hibbert. Five children were in care along with Licensee's minor child/assistant.

The purpose of today's inspection is to ensure compliance with a previously cited deficiencies on January 18, 2018. The following corrections have been made:

- Licensee has purchased and installed a Carbon Monoxide detector.
- Fire extinguisher has been purchased and is now located in main play area of home.
- Latches have been placed in kitchen making all hazardous items inaccessible.

Licensee has placed a lock on gate that leads to backyard where jacuzzi is located. Licensee has purchased and attempted to install new locks on jacuzzi. The new locks do not fit current cover latches. New jacuzzi cover will have to be purchased or Licensee may empty jacuzzi. Licensee is to provide agency with a new plan of correction by tomorrow, January 30, 2018. In the mean time, Licensee will continue to ensure gate that leads to backyard is locked, living room door that leads to backyard will also remain locked as well as continue to use bricks on top of jacuzzi to ensure cover cannot be lifted.

Although corrections have been made, Licensee was only able to provide an Acknowledgment of Receipt for one of the children in care. Licensee is to ensure Facility Evaluation Report dated 1/18/18 is provided to parents and Acknowledgment of Receipts LIC9224 is obtained for all children in care. Deficiency is cited on LIC809-D. A copy of this report along with LIC809-D and appeal rights (LIC 9058) were left at facility. Licensee’s signature on this form acknowledges receipt of these rights. An exit interview was conducted.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Iman KayyaliTELEPHONE: (619) 767-2223
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2018
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: HIBBERT, BARBARA FAMILY CHILD CARE
FACILITY NUMBER: 376624202
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/29/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/31/2018
Section Cited
HSC
1596.8595(c)
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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 that represents an immediate risk to the health, safety, or personal rights of children in care as specified in paragraph (1) of subdivision (a) of Section 1596.893b. Licensee was unable to provide
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Per Licensee, she has not obtained the forms back from parents. Licensee will ensure a copy of Facility Evaluation Report dated 1/18/18 is provided to parents and ensures LIC9224 is obtained. Copies are to be submitted to Licensing Agency as proof of correction by Wednesday, January 31, 2018.
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LIC9224 (Acknowledgment of Receipt) for children in care. This poses a potential Health & Safety risk to clients 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: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Iman KayyaliTELEPHONE: (619) 767-2223
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2018
LIC809 (FAS) - (06/04)
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