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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
376628452
Report Date:
06/16/2023
Date Signed:
06/16/2023 03:56:12 PM
Document Has Been Signed on
06/16/2023 03:56 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:
DEJESUS, JOCHEBED FAMILY CHILD CARE
FACILITY NUMBER:
376628452
ADMINISTRATOR:
JOCHEBED DEJESUS
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(619) 781-8969
CITY:
CHULA VISTA
STATE:
CA
ZIP CODE:
91910
CAPACITY:
14
TOTAL ENROLLED CHILDREN:
14
CENSUS:
7
DATE:
06/16/2023
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
12:05 PM
MET WITH:
Marijoyce Nepomuceno
TIME COMPLETED:
04:00 PM
NARRATIVE
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On 6/16/2023, at 12:05 p.m., Licensing Program Analyst (LPA), Adrian Castellon conducted an unannounced Required - 1 Year Inspection and met with assistant Marijoyce Nepomuceno. Also present was assistant Nizette Agoncill . LPA Castellon disclosed the purpose of the inspection and was granted entry into the facility by licensee after approximately 25 minutes. Seven children were present in the facility during this inspection. The assistant accompanied LPA inside and out of the facility during this inspection. The following areas are used for daycare purposes: entire first floor and fully fenced backyard. Second floor is not used for daycare purposes. The staircase is not properly barricaded. The fire extinguisher, smoke detector, and carbon monoxide detector meet licensing requirements. All hazardous items are inaccessible to children. The storage areas for cleaning supplies and other toxins are secured. Assistant is reminded that criminal record clearance or exemption, or transfer of existing clearance or exemption, are prior to initial presence in a licensed Family Child Care Home is required. 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. Staff First Aid and CPR certifications are valid through 7/23 . Staff has required immunizations. The facility roster is not available for review. The fire and disaster drills requirement is not met. Assistant mandated reporter requirement is not met. The licensee has toys, play equipment, and materials available for children. Per the licensee, there are no firearms maintained at the facility. There are no bodies of water located on the premises. Facility files were reviewed on this date. LPA discussed the safe sleep regulations with licensee and discussed 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. LPA also informed 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 items. LIC 9227 is to be used as part of the Safe Sleep requirements.
SUPERVISORS NAME
:
Cynthia Gray
LICENSING EVALUATOR NAME
:
Adrian Castellon
LICENSING EVALUATOR SIGNATURE
:
DATE:
06/16/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/16/2023
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
7
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:
DEJESUS, JOCHEBED FAMILY CHILD CARE
FACILITY NUMBER:
376628452
VISIT DATE:
06/16/2023
NARRATIVE
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LPA discussed the following: Report suspected child abuse and neglect, maintaining children’s records according to regulation, post all required forms, and ensure that all adults residing or working in the home have criminal background clearances or exemptions. The licensee was reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers, and/or similar equipment are not allowed in daycare. LPA and Licensee discussed California Megan's Law and LPA provided:
www.meganslaw.ca.gov
.
LPAs 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.
Incidental Medical Services (IMS) policy was discussed. Licensee does provide IMS at this time, For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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
.
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/process
.
Deficiencies cited. An exit interview was conducted with assistant Neponucemo . Licensee was advised to post LIC9213 NOTICE OF SITE VISIT for 30 days. Appeal rights discussed and given on this date.
SUPERVISORS NAME
:
Cynthia Gray
LICENSING EVALUATOR NAME
:
Adrian Castellon
LICENSING EVALUATOR SIGNATURE
:
DATE:
06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/16/2023
LIC809
(FAS) - (06/04)
Page:
2
of
7
Document Has Been Signed on
06/16/2023 03:56 PM
- It Cannot Be Edited
Created By:
Adrian Castellon
On
06/16/2023
at
02:27 PM
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:
DEJESUS, JOCHEBED FAMILY CHILD CARE
FACILITY NUMBER:
376628452
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
06/16/2023
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)(1)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or
This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on record review, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. Assistant Nizette Agoncillo has been employed at the facility for at least one month without proper clearances.
POC Due Date:
06/23/2023
Plan of Correction
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2
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Assistant Nizette Agoncillo must submit prints to LIVESCAN office and may not work at the facility unitl clearances have been received and prints associated.
Section Cited
Deficient Practice Statement
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2
3
4
POC Due Date:
Plan of Correction
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2
3
4
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:
Cynthia Gray
LICENSING EVALUATOR NAME:
Adrian Castellon
LICENSING EVALUATOR SIGNATURE:
DATE:
06/16/2023
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/16/2023
LIC809
(FAS) - (06/04)
Page:
3
of
7
Document Has Been Signed on
06/16/2023 03:56 PM
- It Cannot Be Edited
Created By:
Adrian Castellon
On
06/16/2023
at
02:27 PM
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:
DEJESUS, JOCHEBED FAMILY CHILD CARE
FACILITY NUMBER:
376628452
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
06/16/2023
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(3)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (3) Where children are less than five years old are in care, stairs shall be fenced or barricaded.
This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on observation record review, the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care. Staircase not barricaded as required.
POC Due Date:
06/23/2023
Plan of Correction
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Staircase must be properly barricaded. Picture will be submitted as proof of correction by POC date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:
Cynthia Gray
LICENSING EVALUATOR NAME:
Adrian Castellon
LICENSING EVALUATOR SIGNATURE:
DATE:
06/16/2023
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/16/2023
LIC809
(FAS) - (06/04)
Page:
4
of
7
Document Has Been Signed on
06/16/2023 03:56 PM
- It Cannot Be Edited
Created By:
Adrian Castellon
On
06/16/2023
at
02:27 PM
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:
DEJESUS, JOCHEBED FAMILY CHILD CARE
FACILITY NUMBER:
376628452
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
06/16/2023
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)1
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child care home.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
06/23/2023
Plan of Correction
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Staff will practice emergency exit drills with children in care at least once every six months. Next drill will be practiced before 6/23/23 and documented. Documentation will be submitted to licesning office bby POC date.
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:
Cynthia Gray
LICENSING EVALUATOR NAME:
Adrian Castellon
LICENSING EVALUATOR SIGNATURE:
DATE:
06/16/2023
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/16/2023
LIC809
(FAS) - (06/04)
Page:
5
of
7
Document Has Been Signed on
06/16/2023 03:56 PM
- It Cannot Be Edited
Created By:
Adrian Castellon
On
06/16/2023
at
02:27 PM
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:
DEJESUS, JOCHEBED FAMILY CHILD CARE
FACILITY NUMBER:
376628452
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
06/16/2023
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on record review, the staff Marijoyce Neponucemo did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
06/23/2023
Plan of Correction
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2
3
4
Staff Marijoyce Neponucemo must complete required Mandated Reporter Training and submit proff to licensing office by POC date.
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. Staff Marijoyce Neponucemo could not provide proof of required adult immunizations (MMR and TDAP)
POC Due Date:
06/23/2023
Plan of Correction
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2
3
4
Staff shall submit proof of required immunizations by POC date.
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:
Cynthia Gray
LICENSING EVALUATOR NAME:
Adrian Castellon
LICENSING EVALUATOR SIGNATURE:
DATE:
06/16/2023
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/16/2023
LIC809
(FAS) - (06/04)
Page:
6
of
7
Document Has Been Signed on
06/16/2023 03:56 PM
- It Cannot Be Edited
Created By:
Adrian Castellon
On
06/16/2023
at
02:27 PM
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:
DEJESUS, JOCHEBED FAMILY CHILD CARE
FACILITY NUMBER:
376628452
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
06/16/2023
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, 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. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. Staff member Marijoyce Neponucemo could not provide proof on flu shot or documentation that shot would not be taken.
POC Due Date:
06/23/2023
Plan of Correction
1
2
3
4
Marijoyce Neponucemo will submit proof of required flu shot or documentation that shot will not be taken.
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
06/23/2023
Plan of Correction
1
2
3
4
Licensee must submit proof of fully completed roster by POC date.
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:
Cynthia Gray
LICENSING EVALUATOR NAME:
Adrian Castellon
LICENSING EVALUATOR SIGNATURE:
DATE:
06/16/2023
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/16/2023
LIC809
(FAS) - (06/04)
Page:
7
of
7