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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376616064
Report Date: 08/31/2022
Date Signed: 08/31/2022 05:31:57 PM

Document Has Been Signed on 08/31/2022 05:31 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:ACOSTA, BLANCA FAMILY CHILD CAREFACILITY NUMBER:
376616064
ADMINISTRATOR:BLANCA ACOSTAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 737-0026
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY: 14TOTAL ENROLLED CHILDREN: 7CENSUS: 6DATE:
08/31/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:53 PM
MET WITH:BLANCA ACOSTATIME COMPLETED:
05:30 PM
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On 08/31/2022, at 1:53 p.m., Licensing Program Analyst (LPA) Claudia Amador conducted an unannounced Annual Inspection and met with Licensee Blanca Acosta and Assistant Esther Romero. LPA disclosed the purpose of the inspection and was led on a tour of the facility indoors and outdoors. This facility is a 3- bedroom, 3- bath one story home. Areas that may be used for childcare are; the playroom, bathroom in the playroom and the back yard. Off-limit areas are the kitchen, dining room, living room, bedrooms, hallway bathroom and the master bathroom, which remain inaccessible during day-care hours with a child safety gate.

Hours of operation hours are Monday – Sunday, 12:00 am to 11:59 pm. There were no children present during the inspection. After 3:00 pm the assistant picked up six (6) children from Kellogg Elementary School, five (5) school age and one (1) pre school age.

The fire extinguisher, smoke detector, and carbon monoxide detector met the requirements. Hazardous items were not made inaccessible to children in care. LPA informed licensee poisons should be placed in a storage area and locked. Assistant locked the paint immediately in the storage during the inspection. The storage is locked and outside. Technical Violation was issued.

LPA observed toys and materials available for children’s use. The home has a fenced backyard available for outdoor activities. LPA informed the licensee to ensure children are supervised at all times during outdoor activities. The licensee stated there were no bodies of water, and LPA did not observe any bodies of water during the inspection. The licensee said there were no firearms, other weapons, or ammunition in the home.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Claudia Amador
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2022
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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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: ACOSTA, BLANCA FAMILY CHILD CARE
FACILITY NUMBER: 376616064
VISIT DATE: 08/31/2022
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A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal records and child abuse clearances or exemptions.

LPA reviewed children’s files. The children’s files reviewed were complete and met regulations.

The licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption or transfer their existing clearance or exemption prior to the initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Licensee’s and assistant's Mandated Reporter AB1207 training expired, a technical violation was issued. Licensee’s and assistant's Pediatric CPR and First Aid certifications expire on 05/2024. Licensee’s and assistant's First Aid and CPR certifications are valid and expire on 05/2024.

The licensee has required immunizations and will provide copy of the records for
Licensee and assistant. The facility roster is maintained and reviewed. The last fire and disaster drills were conducted and documented on 08/26/2022. Required documents are posted. There is one crib or play yard for each infant who cannot climb out of the crib or play yard.

The incidental Medical Services (IMS) policy was discussed. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

LPA discussed safe sleep regulations with the licensee and the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. No Sleep Log for infant, technical violation was issued.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Claudia Amador
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022
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: ACOSTA, BLANCA FAMILY CHILD CARE
FACILITY NUMBER: 376616064
VISIT DATE: 08/31/2022
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LPA also informed the licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPA and licensee discussed California Megan's Law, and LPA provided: www.meganslaw.ca.gov.
LPA discussed and provided Licensee with the following: child care advocates email address: [email protected]. In addition, for general questions or questions regarding licensing requirements, contact the Child Care Licensing Duty Line at (619) 767-2248.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters, and other important information communication platforms. To receive important information about licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.
LPA reviewed with licensee the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to [email protected]. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/tion-process.

No deficiencies were issued during today's inspection.
Notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report reviewed with Blanca Acosta. 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.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Claudia Amador
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022
LIC809 (FAS) - (06/04)
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