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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073403811
Report Date: 08/27/2019
Date Signed: 08/27/2019 01:52:04 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:LEE-OLORTEGUI, SILVIAFACILITY NUMBER:
073403811
ADMINISTRATOR:LEE-OLORTEGUI, SILVIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 288-1956
CITY:CONCORDSTATE: CAZIP CODE:
94519
CAPACITY:14CENSUS: 6DATE:
08/27/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:LEE-OLORTEGUI, SILVIA, LICENSEETIME COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Redmond conducted an unannounced, Complaint Investigation visit, on 08/13, 0821 and 08/27/2019.

During the course of the investigation, LPA met with Silvia Lee-Olortegui, Licensee on each day. LPA conducted interviews of the Licensee, her husband (who assists in the facility), a staff person working at the facility on that date and parents of children who have been enrolled at the facility over the past three years. During interviews, LPA determined that Licensee, was dishonest when asked questions about the following issues:

102402 (a)(3) - Revocation or Suspension of a License or Registration

1. At or about June through first week of July 2019, Licensee and her husband went on vacation. When LPA asked Licensee about at first denied going on vacation, LPA obtained information that the facility was closed for approximately one week.

2. When LPA asked Licensee if the facility was open or closed while the Licensee was on vacation, Licensee initially denied being opened. LPA obtained information that the Licensee was opened while the Licensee was on vacation at that at least one staff person was left providing care and supervision to the children in care at the facility.

3. When LPA asked Licensee if a third person (identified during interviews) had access to and or was left alone with children in care at the facility, the Licensee and staff person denied that a person had access to and was left alone with children in care at the facility. LPA obtained information that there was a third, female having access to and being left alone with children at the facility. This person does not have a criminal background clearance and is not associated to the facility. This is a ZERO TOLERANCE violation. Therefore, the Licensee has been cited and assessed civil penalties - $100 per day for a maximum of 5 days = $500.



SUPERVISOR'S NAME: Antranette RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen RedmondTELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2019
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: LEE-OLORTEGUI, SILVIA
FACILITY NUMBER: 073403811
VISIT DATE: 08/27/2019
NARRATIVE
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Exit Interview: An exit interview has been conducted with the Licensee. This Complaint Investigation Report, Plan of Correction (POC), Appeal Rights and Notice of Site Visit was issued to and discussed with the Licensee.

Notice of Site Visit: Shall be posted at the time of the inspection and shall remain posted for 30 days.

Record Retention: This Complaint Investigation Report and POC shall be made available to the public upon request for 3 years from the date of this report. A copy of the report shall also be provided to newly enrolled children at the facility during the next 12 months and a copy of the LIC 9224 shall be placed in the children’s files.
SUPERVISOR'S NAME: Antranette RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen RedmondTELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2019
LIC809 (FAS) - (06/04)
Page: 5 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: LEE-OLORTEGUI, SILVIA
FACILITY NUMBER: 073403811
VISIT DATE: 08/27/2019
NARRATIVE
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When LPA asked Licensee for Child Care Facility Roster, the Licensee provided LPA a copy of the roster, which, the roster must be completed for all children who are enrolled and or have left the facility over the past 3 years. When LPA asked Licensee if there were any other children (besides those listed on the roster) were enrolled and or left within the past three (3) months, Licensee denied that there were additional children. It was not until LPA interviewed staff did Licensee admit to other children being enrolled but not listed on the Child roster.

NOTICE: A violation of Title 22 Health and Safety Regulations has occurred. Deficiencies have been cited and a Plan of Correction (POCs) has issued to the Licensee, in order to correct the deficiency (see LIC 809D form).
Instructions for clearing the POCs

A serious deficiency, which is a Type A violation, has being cited on the POC form.

The POC shall be *corrected within 24 hours.

The Licensee shall post and provide copies of the Complaint Investigation Report and POC to all parents/guardians of children currently enrolled and in care at the facility.

All parents/guardians shall sign an Acknowledgement of Receipt of Licensing Report (LIC9224) and a copy shall be placed in each child's file.

A list compiled of the parent's signatures including the date the LIC 9224 was signed shall be compiled.

The completed POC and the list parent signatures shall be faxed to:

ATTENTION: LPA REDMOND (510) 622-2641

CONTINUED
SUPERVISOR'S NAME: Antranette RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen RedmondTELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2019
LIC809 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: LEE-OLORTEGUI, SILVIA
FACILITY NUMBER: 073403811
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/27/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/28/2019
Section Cited

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"Prior to employment or initial presence in the child care home, all employees and volunteers subject to a criminal record review shall:(1)Obtain a California clearance or a criminal record exemption as required by law or Department regulations (See section cited for a complete description of
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section). LPA OBSERVED: LICENSEE DID NOT MEET THIS REQUIREMENT: Licensee had no evidence of a criminal background clearance or association for one out of three staff present, (S1). Per Licensee, there are no other records at facility. This poses an immediate risk to children in care. "
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 2. Licensee shall provide evidence of ciminal record clearance or provide a written and signed statement that the individual is no longer working or residing in the facility.
A CIVIL PENALTY OF $500 HAS BEEN ASSESSED AND WILL CONTINUE TO ACCRUE UNTIL THIS POC IS CLEARED.
Type A
08/28/2019
Section Cited

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Revocation or Suspection of a License or Registration: Conduct in the operation or maintenance of a family day care home which is inimical to the health, morals, welfare, or safety of either an individual...(See section cited for complete description). THIS REQUIREMENT WAS NOT MET. SEE
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LIC 809 FOR COMPLETE DESCRIPTIONS OF VARIOUS DEFICIENCIES UNDER THIS SECTION.
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ment of up to $100 per day, per violation.
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: Antranette RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen RedmondTELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:
DATE: 08/27/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/27/2019
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: LEE-OLORTEGUI, SILVIA
FACILITY NUMBER: 073403811
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/27/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/03/2019
Section Cited

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Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

LICENSEE DID NOT MEET THIS REQUIREMENT: Licensee's current roster did not list the children currently enrolled in care.
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Per Licensee, there are no other facility records. This poses a potential health and safety risk to children in care if not corrected.
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due date may result in civil penalties assessed at $100 per day, per violations.

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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: Antranette RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen RedmondTELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:
DATE: 08/27/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/27/2019
LIC809 (FAS) - (06/04)
Page: 4 of 5