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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073404172
Report Date: 04/26/2023
Date Signed: 04/26/2023 04:32:08 PM


Document Has Been Signed on 04/26/2023 04:32 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:VERDUZCO, LISAFACILITY NUMBER:
073404172
ADMINISTRATOR:VERDUZCO, LISAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 234-9988
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY:14CENSUS: 4DATE:
04/26/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:51 PM
MET WITH:Lisa VerduzcoTIME COMPLETED:
04:35 PM
NARRATIVE
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Regional Manager (RM) Diane Perez, Licensing Program Manager (LPM) Sherelle Johnson and Licensing Program Analyst (LPA) Diana Campos met with licensee Lisa Verduzco for an unannounced Case Management inspection as a result of a Temporary Suspension Order served to the child care home today. Present during this inspection were licensee, her spouse, minor son and 4 children in care..
A review of interviews conducted by the Antioch Police Department, Community Care Licensing Investigations Branch records indicates that licensee Lisa Verduzco provided misleading or false information to refuse entry to licensing staff to the child care home. Therefore, she is being cited for her conduct, which is inimical - Conduct which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of this state.

See 809D for Type A deficiencies cited today. TSO packets were provided for parents of children in care.

Exit interview and report reviewed with Lisa Verduzco.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Diana CamposTELEPHONE: (510) 873-6322
LICENSING EVALUATOR SIGNATURE:
DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/26/2023
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 04/26/2023 04:32 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: VERDUZCO, LISA
FACILITY NUMBER: 073404172

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/26/2023
Section Cited

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The department may deny an application for or suspend or revoke any license, registration, or special permit issued under this act upon any of the following grounds and in the manner provided in this act:(c) Conduct which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of this state.This regulation was not met as evidenced by:
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TSO was served today.
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Refusing entry under false pretenses and deceitful measures to local law enforcement, IB Investigations Branch and LPA's on numerous occasions.
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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) 622-2592
LICENSING EVALUATOR NAME: Diana CamposTELEPHONE: (510) 873-6322
LICENSING EVALUATOR SIGNATURE:
DATE: 04/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/26/2023
LIC809 (FAS) - (06/04)
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