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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376627831
Report Date: 09/25/2026
Date Signed: 09/25/2026 04:38:34 PM

Document Has Been Signed on 09/25/2026 04:38 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:MEDINA, MARY FAMILY CHILD CAREFACILITY NUMBER:
376627831
ADMINISTRATOR/
DIRECTOR:		MARY MEDINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 251-6067
CITY:SAN DIEGOSTATE: CAZIP CODE:
92110
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 8DATE:
09/25/2026
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:10 PM
MET WITH:Mary MedinaTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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On 9/25/26 at 2:10p, Licensing Program Analyst (LPA) Qwatevyia Edwards conducted an unannounced annual inspection. LPA identified herself, disclosed the purpose of the inspection, and was granted entry into the home. LPA met with Licensee, Mary Medina. The Licensee was provided with the Entrance Checklist (LIC 126).

Present in the home was the Licensee's spouse, Lionel Medina, who serves as her helper. The Licensee stated that there are eight children enrolled in care. During the inspection, eight daycare children were present, including one infant and seven toddlers. Proper supervision, ratios, and capacity were observed during the visit. Two toddlers were picked up at 3:40p, and one infant at 3:49p.

The one-story home was toured and inspected to ensure a safe environment for the care and supervision of children. Licensee has provided adequate space for children to eat, sleep, and play within the home. Areas used for childcare include the living/dining room, bathroom, and covered patio. The Licensee updated the facility sketch to include the master bedroom and Bedroom #2 as on-limit areas to accommodate additional infant sleeping space. The fully fenced backyard remains off-limits for childcare and is utilized by parents for child drop-off and pick-up.

The fire extinguisher, smoke detector, and carbon monoxide detector meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. Licensee states that there are no weapons in the home. The fireplace is screened. There is a working phone at the facility, telephone number verified.
(Cont...page 2)
Renesha Askew
Qwatevyia Edwards
DATE: 09/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/25/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: MEDINA, MARY FAMILY CHILD CARE
FACILITY NUMBER: 376627831
VISIT DATE: 09/25/2026
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The home has a fully-fenced, back patio play area available for outdoor activities. No hazards were noted. Parents also drop off at the back patio door. Outdoor play area has age-appropriate play equipment in good condition. The licensee understands that visual supervision is always required during outdoor activities. No body of water was observed during time of inspection.

A current roster is on file, and required postings, including the Facility Sketch, Emergency Disaster Plan, and Notification of Parent’s Rights, are displayed. Fire and disaster drill documentation is maintained, with the last drill conducted on 08/03/2026.

LPA reviewed staff files and found them to be incomplete. Licensee’s and Helper First Aid and CPR certifications expire on 09/06/2027. Mandated Reporter for the Licensee and Helper has and must be renewed. Licensee is reminded that both their CPR certification and Mandated Reporter Training must be renewed every two years. Licensee and staff meet immunization requirements. https://mandatedreportertraining.com/california/



Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA reminded Licensee that all unusual incident reports shall be submitted to Licensing office via email at [email protected] or via fax at (619) 767-2203.

Provider is hereby reminded of the following requirements: report all suspected child abuse and neglect; maintain children’s records in accordance with licensing regulations; and post all required forms and notices. In addition, corporal punishment and smoking are prohibited in the daycare setting. The use of exersaucers, bouncy seats, walkers, and jumpers is also prohibited in daycare. All equipment that is used should be used only as intended by the manufacturer. Licensee states they are registered to receive Provider Information Notices (PINs). 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. (Cont...page 3)
NAME OF LICENSING PROGRAM MANAGER: Renesha Askew
NAME OF LICENSING PROGRAM ANALYST: Qwatevyia Edwards
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2026
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: MEDINA, MARY FAMILY CHILD CARE
FACILITY NUMBER: 376627831
VISIT DATE: 09/25/2026
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The Licensee provided proof of control of property. The licensee owns the property.

LPA discussed the safe sleep regulations with licensee [or facility representative] and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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 equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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 publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

See LIC9102TV for technical violations provided.



Exit interview conducted and report was reviewed with the Licensee Mary Medina.
During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. A notice of site visit was given and must remain posted for 30 days.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.
NAME OF LICENSING PROGRAM MANAGER: Renesha Askew
NAME OF LICENSING PROGRAM ANALYST: Qwatevyia Edwards
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2026
LIC809 (FAS) - (06/04)
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