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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073403811
Report Date: 01/03/2023
Date Signed: 01/03/2023 04:37:31 PM


Document Has Been Signed on 01/03/2023 04:37 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, 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: 5DATE:
01/03/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Silvia Lee-OloreteguiTIME COMPLETED:
04:45 PM
NARRATIVE
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THIS REPORT WAS CONDUCTED IN ENGLISH AND SPANISH, INTERPETRED BY LPA INDIRA LOZA.

On 01/03/2023 at 2:40 PM, Licensing Program Analyst (LPA) Christina Watts conducted a unannounced Case Management inspection at Silvia Lee-Olortegui’s large family home. LPA met with licensee, Silva Lee-Olortegui. During today’s inspection, there were 5 children (2 infants and 3 preschool aged children) and 1 aid. Present during the inspection was licensee, licensee's spouse and licensee 2 minor children ages 14 and 16 years old.

See 809-D for Type A deficiencies being cited today for licensee failing to adequately supervise daycare child. Statement from licensee show she left child sitting alone at the table while she sat in a different area for approximately 15 minutes with child’s back to her with no direct view of the child as she helped her assistant supervise other daycare children in the living room. Licensee admitted she alters highchair she orders online to fit her needs. She removed the safety belts and added wooden dowel to the highchair.

See 809-D for Type B deficiency being cited today for licensee failing to report incident to licensing. Licensee stated she did not write an incident report, but she informed the parent of the above incident.

LPA informed licensee that this report dated (date) with 2 Type A citations which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA informed licensee to provide copy of this licensing report dated 01/03/2023 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

LPA informed licensee that this report dated 01/03/2023 documents a Type B citation. Type B citation(s) are a potential risk(s) to the health, safety, or personal rights of children in care.*Con't on page 2*

SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina WattsTELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:
DATE: 01/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/03/2023
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 4


Document Has Been Signed on 01/03/2023 04:37 PM - It Cannot Be Edited

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: 01/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/04/2023
Section Cited

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102423 Personal Rights (a) Each child receiving services from a family childcare home shall have certain rights that shall not be waived or abridged by the licensee...These rights in include...(4) To be free from corporal or unusual punishment, infliction of pain...or other actions of a punitive nature...
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By COB 01/04/2023, licensee will submit statement regarding how licensee supervise children in care.
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This requirement has not been met as evidenced by: licensee admittedly left infant unsupervised and infant hit their head on table, causing bruising which poses an immediate risk to the health, safety, or personal rights of children in care.
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Type A
01/04/2023
Section Cited

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102423 Personal Rights(a) Each child receiving services from a family childcare home shall have certain rights that shall not be waived or abridged by the licensee...These rights include... (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.
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By COB 01/04/2023, will purchase high chair with table without alteration to chair to prevent injury. Licensee will write statement regarding supervision while in highschair.
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This requirement has not been met as evidenced by: Licensee admitted to altering the highchair which cause infant to hit their head on table and injured themselves which poses an immediate risk to the health, safety, or personal rights 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: Sherelle JohnsonTELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina WattsTELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:
DATE: 01/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/03/2023
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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: LEE-OLORTEGUI, SILVIA
FACILITY NUMBER: 073403811
VISIT DATE: 01/03/2023
NARRATIVE
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*Page 2*

Licensee was informed that a Non-Compliance Conference will be scheduled to discuss recent deficiencies.


Exit interview was conducted and report was reviewed with licensee, Silvia Lee-Olortegui. A Notice of Site Visit was given and must remain posted for 30 consecutive days.

SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina WattsTELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 01/03/2023 04:37 PM - It Cannot Be Edited

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: 01/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/04/2023
Section Cited

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102416.2 Reporting Requirements (b) The licensee shall report to the Department any of the event...that occur during the operation of the family child care home...(3) ..."A report shall be made to the Department…(B)...injury to any child that requires medical treatment.(C) Any unusual incident...
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By COB 01/06/2023, licensee will write a policy regarding the plan of action for reporting injuries or any medical treatment that a child receives.
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...that threatens the physical or emotional health or safety..."This requirement has not been met as evidenced by: Licensee admitting she did not report child hitting their head on the table and bruising themselves to licensing which poses a potential risk to the health, safety, or personal rights 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: Sherelle JohnsonTELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina WattsTELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:
DATE: 01/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/03/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4