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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376627668
Report Date: 09/08/2021
Date Signed: 09/08/2021 08:28:42 PM

Document Has Been Signed on 09/08/2021 08:28 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:MENDS-COLE, JESSICA & BROWN, CANDACE FCCFACILITY NUMBER:
376627668
ADMINISTRATOR:JESSICA MENDS-COLEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 494-9889
CITY:SAN DIEGOSTATE: CAZIP CODE:
92123
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
09/08/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Licensee, Candace Brown TIME COMPLETED:
11:30 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Jennifer Lott and Leandra Doiolliole conducted an unannounced case management visit to cite unrelated deficiencies noted during a previous visit from 07/01/2021 and 09/08/2021. Licensee Brown was informed of the violations. During the 09/08/2021 site visit, it was revealed that the licensee did not inform Community Care Licensing that a child (C1) had contracted a contagious disease (D1).

Therefore, a deficiency is being cited per Title 22, Div. 6 Regulations and listed on LIC 809-D. An exit interview was conducted with Licensee Brown and a copy of this report along with the Appeal and Licensee's Rights (LIC 9058, 01/16) and Confidential Names (LIC 811) were provided. Signature on this form below, confirms receipt.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Jennifer Lott
LICENSING EVALUATOR SIGNATURE: DATE: 09/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2021
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 09/08/2021 08:28 PM - It Cannot Be Edited


Created By: Jennifer Lott On 09/08/2021 at 10:07 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: MENDS-COLE, JESSICA & BROWN, CANDACE FCC
FACILITY NUMBER: 376627668

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/22/2021
Section Cited
CCR
102416.2(c)(3)

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Reporting Requirements - ...The licensee shall report the following events to the Department: A communicable diesase outbreak when determined by the local health authority. This requirement is not met as evidenced by:
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Licensee states they will submit an Unusual Incident Report of the communicable disease outbreak by fax or email by POC date.
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Based on interviews with outside sources and outside source records, licensee did not report a communicable disease outbreak. This poeses a potential health and safety 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:Tashima Daniel
LICENSING EVALUATOR NAME:Jennifer Lott
LICENSING EVALUATOR SIGNATURE:
DATE: 09/08/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/08/2021


LIC809 (FAS) - (06/04)
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