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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376627287
Report Date: 09/13/2023
Date Signed: 09/13/2023 03:59:10 PM

Document Has Been Signed on 09/13/2023 03:59 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:SOMMERVILLE, JESSICA FAMILY CHILD CAREFACILITY NUMBER:
376627287
ADMINISTRATOR:JESSICA SOMMERVILLEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 592-3935
CITY:SANTEESTATE: CAZIP CODE:
92071
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
09/13/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Jessica SommervilleTIME COMPLETED:
01:45 PM
NARRATIVE
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On 9/12/23 at 1:15 PM Licensing Program Analyst (LPA) conducted a Case Management - Deficiency visit as deficiencies were observed while conducting a complaint inspection. During the visit, LPA observed that there were three infants in care and one crib with a mattress two inches too short and one playpen available. Licensee stated that she has a third crib that she cannot use at this time as one her dogs ate the mattress.

See LIC809-D for deficiencies cited during the inspection.

An exit interview was conducted with licensee, Jessica Sommerville. A notice of site visit was given to Licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2023
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 2
Document Has Been Signed on 09/13/2023 03:59 PM - It Cannot Be Edited


Created By: Adrian L Mangina On 09/13/2023 at 02:34 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: SOMMERVILLE, JESSICA FAMILY CHILD CARE
FACILITY NUMBER: 376627287

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/14/2023
Section Cited
CCR
102425(a)(4)

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Infant Safe Sleep: Mattresses shall be made specifically for the size crib or play yard in which they are placed.

This requirement was not met as evidenced by:
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Licensee states will replace mattress or crib if properly fitting mattress not available for purchase and will provide proof to LPA no later than close of business 9/14/23.
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Based on observation, Licensee did not comply with requirement above as Licensee has a crib with a mattress two inches shorter than the crib which poses a potential health, safety, or personal rights risk to children in care.
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Type B
09/14/2023
Section Cited
CCR102425(a)

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Infant Safe Sleep:There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard.

This requirement was not met as evidenced by:
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Licensee states will purchase enoug crib/playpens for the number of infants in care and will provide proof to LPA no later than 9/14/23. Licensee states until in future, will not allow more infants in care than she has cribs/playpens.
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Based on observation, Licensee did not comply with requirement above as Licensee has one playpen and foru infants in care which poses a potential health, safety, or personal rights risk to children 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:Renesha Askew
LICENSING EVALUATOR NAME:Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2023


LIC809 (FAS) - (06/04)
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