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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376613387
Report Date: 02/22/2022
Date Signed: 02/22/2022 11:32:08 AM

Document Has Been Signed on 02/22/2022 11:32 AM - 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:BAHENA, MARGARITA & ANDRES FAMILY CHILD CAREFACILITY NUMBER:
376613387
ADMINISTRATOR:MARGARITA BAHENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 231-1054
CITY:SAN DIEGOSTATE: CAZIP CODE:
92113
CAPACITY: 14TOTAL ENROLLED CHILDREN: 4CENSUS: 1DATE:
02/22/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Margarita BahenaTIME COMPLETED:
11:30 AM
NARRATIVE
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On 02/22/22 at 10:30AM, LPA Luigi Gargaro, conducted an unannounced case management visit to the facility to deliver two citations to the licensee related to violations that were found to have occurred in relation to a recent complaint investigation. It was determined that the licensee was found to have not reported incidents related to her day care operation as required by regulation and to not have been truthful to the Department when discussing those incidents. One type A and one type B violation, respectively, from the California Code of Regulations, (Title 22, Division 12 & Chapter 3), are being cited on the attached LIC 809-D.

Upon Receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

An exit interview was conducted with the licensee. The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.

LPA provided notice of site visit and observed it being posted at the facility.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2022
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 02/22/2022 11:32 AM - It Cannot Be Edited


Created By: Luigi Gargaro On 02/22/2022 at 08:34 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: BAHENA, MARGARITA & ANDRES FAMILY CHILD CARE
FACILITY NUMBER: 376613387

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/22/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/23/2022
Section Cited
HSC
1596.885(c)

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1596.885(c) The department may…revoke any license…issued under this act upon any of the following grounds and in the manner provided in this act: (c) Conduct which is inimical to the health, morals… welfare, or safety of either an individual in or receiving services from the facility…This requirement was not met as evidenced by:
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Analyst and licensee discussed the Licensee's obligation to be truthful with the Department in all her interactions with them and her relation of all incidents that affect the day care. Licensee states she will submit a written statement to that effect to analyst to comfirm this and address the deficiency by 02/23/22.
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Based on the confidential interviews and reviewed reports, it was determined that the Licensee was untruthful with the Department regarding five separate visits that were conducted by the San Diego Police Department to her home This poses an immediate health and safety risk to children.
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LPA also informed licensee that this information will be forwarded to the Department’s Legal Division for further review for an ongoing administrative action.

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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:Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:
DATE: 02/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/22/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/02/2022 12:30 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 03/02/2022 11:33 AM


Created By: Luigi Gargaro On 02/22/2022 at 08:48 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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: BAHENA, MARGARITA & ANDRES FAMILY CHILD CARE
FACILITY NUMBER: 376613387

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/22/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/28/2022
Section Cited
CCR
102416.2(b)

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102416.2(b) Reporting Requirements - 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 child care home. This requirement was not met as evidenced by:
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Licensee and analyst discussed the ongoing requirement to report any incidents that may have an effect on day care operation. Licensee will submit a written statement to analyst attesting the same and also complete and submit an LIC 624B for each incident by 02/28/22
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LPA’s records review and interview with the Licensee. During a complaint investigation for the facility, it was determined that licensee did not report multiple law enforcement visits that may have affected day care operation. This poses a potential health and safety risk to children in care.
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This is a repeat violation of a previously cited 08/18/21 reporting requirement violation.The licensee was cited a corresponding $250 civil penalty for the repeat violation within 12 months of the original one.

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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:Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:
DATE: 03/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2022


LIC809 (FAS) - (06/04)
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