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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073404172
Report Date: 06/03/2021
Date Signed: 06/03/2021 05:36:21 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:VERDUZCO, LISAFACILITY NUMBER:
073404172
ADMINISTRATOR:VERDUZCO, LISAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(925) 234-9988
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY:14CENSUS: DATE:
06/03/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:LISA VERDUZCOTIME COMPLETED:
02:00 PM
NARRATIVE
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LICENSING PROGRAM ANALYST ALEXANDER MET WITH LICENSEE LISA VERDUZCO TO DELIVER THE FINDINGS TO A COMPLAINT AND DURING THIS INVESTIGATION IT WAS DISCOVERED THAT A SCHOOL AGE CHILD WAS LEFT UNATTENDED IN A ROOM DURING SOCIAL DISTANCE LEARNING CLASS. THE CHILD WAS ABLE TO OBTAIN A PAIR OF SCISSORS, INAPPROPRIATELY PLAY WITH THEM AND PUT THE SHARP END INTO THEIR MOUTH.

CALIFORNIA TITLE 22 REGULATIONS 102417 STATES THAT LICENSEE SHALL ENSURE THAT CHILDREN IN CARE ARE SUPERVISED AT ALL TIMES.

THE ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS FORM HAS BEEN GIVEN AND EXPLAINED. A COPY OF THIS REPORT IS TO BE GIVEN TO EACH DAY CARE CHILD'S PARENT/GUARDIAN BY THE NEXT BUSINESS DAY AND A SIGNED COPY OF THE ACKNOWLEDGEMENT FORM IS TO BE PUT INTO THEIR CHILD'S FILE. A COPY OF THIS REPORT IS ALSO TO BE GIVEN TO ANY NEWLY ENROLLED CHILD'S PARENT/GUARDIAN WITHIN 1 YEAR. THIS COPY IS TO BE POSTED AT THE FACILITY FOR 30 DAYS.

This report must be available for public review for 3 years. An exit interview was conducted. A notice of site visit was posted.


PLEASE SEE ATTACHED FOR CITATION
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021
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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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: 06/03/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/03/2021
Section Cited

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102417 Operation of a Family Child Care Home
(a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times. THIS REQUIREMENT HAS NOT BEEN MET AS EVIDENCED BY: A SCHOOL AGE CHILD WAS LEFT UNATTENDED AND WAS ABLE TO OBTAIN SCISSORS AND PUT THEM INTO THEIR MOUTH

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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: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:
DATE: 06/03/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/03/2021
LIC809 (FAS) - (06/04)
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