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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628309
Report Date: 09/09/2021
Date Signed: 09/09/2021 02:05:08 PM

Document Has Been Signed on 09/09/2021 02:05 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:JEAN, SHERLINE FAMILY CHILD CAREFACILITY NUMBER:
376628309
ADMINISTRATOR:SHERLINE JEANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 892-6581
CITY:SAN DIEGOSTATE: CAZIP CODE:
92113
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
09/09/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Sherline Jean, LicenseeTIME COMPLETED:
02:05 PM
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On September 9, 2021, at 12:10 PM, Licensing Program Analyst (LPA), Marie Hernandez conducted an unannounced Annual Required Inspection and met with the Licensee, Sherline Jean. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. During the inspection today, there are five children with the Licensee and the adult helper, Delourdes Ullysse. The Licensee accompanied LPA on the tour inside and out of the facility during this inspection. The following areas will be used for child care: The living room, dining room, downstairs bedroom (main day care area) , downstairs bathroom and the side yard. The off limit areas include: The kitchen, the entire upstairs bedrooms, two upstairs bathrooms, rear yard and rear studio home (converted garage). The stairs are barricaded via gate at the bottom of the stairs. There are no bodies of water observed during time of inspection. The fire extinguisher, carbon monoxide and smoke detector meet requirements and are operational. All poisons, cleaners and hazardous items in the home are inaccessible to children through latches, locks, and/or placed on high surfaces. The off limits areas are inaccessible through use of a child proof safety gate. All hazardous items were inaccessible to children. The storage area for poisons is locked. The licensee has toys, play equipment and materials available. The Licensee stated there are no weapons in the home. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received a criminal record and child abuse clearances or exemptions. Licensee’s First Aid and CPR certifications expired on 05/2023. Licensee's has the required immunization's. The Licensee's Mandated Reporter certification expired on 02/19/2021. The mandated reporter certification must be renewed every two years prior to expiration. The Licensee conducted the fire/disaster drill on 09/09/2021. The Infant Safe Sleep plans are maintained and the fifteen minute checks are maintained. LPA provided and discussed the following: Report suspected child abuse and neglect, maintain 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. Licensee was reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers and/or similar equipment are not allowed in day-care. Licensee was also provided handouts with information regarding upcoming Safe Sleep Regulations/SIDS, Lead exposure and Shaken Baby Syndrome. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov. The handout was provided for he SDQPI Every Child Deserves Quality Early Learning Experiences.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Marie Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 09/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: JEAN, SHERLINE FAMILY CHILD CARE
FACILITY NUMBER: 376628309
VISIT DATE: 09/09/2021
NARRATIVE
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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.

Incidental Medical services (IMS) policy was discussed. 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 publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

The following deficiency has been cited today. An exit interview was conducted with the licensee. The licensee was provided a copy of the report, notice of site visit and the appeal rights. LPA observed the Licensee post the notice of site visit during the inspection. The notice must be posted for thirty days.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Marie Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021
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Document Has Been Signed on 09/09/2021 02:05 PM - It Cannot Be Edited


Created By: Marie Hernandez On 09/09/2021 at 01:26 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: JEAN, SHERLINE FAMILY CHILD CARE
FACILITY NUMBER: 376628309

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/17/2021
Section Cited
HSC
1596.8662(40)(b)(1)

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§1596.8662 (40)(b)(1) Availability of information regarding detecting and reporting child abuse and neglect; training for mandated reporter...shall complete renewal mandated reporter training every two years...This requirement was not met as evidenced by: LPA during records review.
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The Licensee and the adult helper will obtain certification of the required mandated child abuse reporting certification (AB1207) by 09/17/2021 and will submit proof to LPA by 09/17/2021. The Licensee will ensure that they will renew their certification every two years prior to it expiring.
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During records review, LPA observed that on 02/19/2021, the Licensee's mandated child abuse certification expired. The adult helper (Delourdes Ullysse) does not have the required mandated reporter certification. This poses a potential health and safety risk to children in care.
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The appeal rights were discussed and provided.

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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:Marie Hernandez
LICENSING EVALUATOR SIGNATURE:
DATE: 09/09/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2021


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