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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376628994
Report Date: 08/10/2023
Date Signed: 01/18/2024 05:21:45 PM

Document Has Been Signed on 01/18/2024 05:21 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:DIAZ, KARLA FAMILY CHILD CAREFACILITY NUMBER:
376628994
ADMINISTRATOR:KARLA DIAZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 934-2494
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
08/10/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Karla DiazTIME COMPLETED:
01:50 PM
NARRATIVE
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*THIS IS AN AMENDED VERSION OF A PREVIOUSLY WRITTEN REPORT

On 8/10/22 at 12:30pm, LPA Adrian Castellon conducted a case management inspection. LPA met with licensee Karla Diaz and discussed the purpose of the inspection. There were nine day-care children present.

During a complaint inspection conducted on this date, LPA Castellon became aware of a licensing infraction during a file review. This LIC809 will be used to document that infraction. Licensee could not provide a complete facility roster on this date.

LPA Castellon discuused appeal rights and gave licensee a copy of the appeal rights.

Type B citation issued on this date.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Adrian Castellon
LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2024
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 01/18/2024 05:22 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 01/18/2024 08:13 AM


Created By: Adrian Castellon On 08/10/2023 at 12:40 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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: DIAZ, KARLA FAMILY CHILD CARE
FACILITY NUMBER: 376628994

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/11/2023
Section Cited
CCR
102417(g)(8)

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102417 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 be limited to: (8) Each family child care home shall have a current roster of children as specified in
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Licensee Diaz will submit a complete facility roster by the POC date to LPA Castellon via email at [email protected].
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Health and Safety Code Section 1596.841. This requirement was not met as evidenced by the licensee not providing a completed Facility Roster upon request during today's inspection. This could pose a threat to the health and safety of 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:Cynthia Gray
LICENSING EVALUATOR NAME:Adrian Castellon
LICENSING EVALUATOR SIGNATURE:
DATE: 01/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/18/2024


LIC809 (FAS) - (06/04)
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