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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409036
Report Date: 05/07/2021
Date Signed: 05/07/2021 11:32:55 AM

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:ODE, VALERIAFACILITY NUMBER:
073409036
ADMINISTRATOR:ODE, VALERIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 313-8268
CITY:RICHMONDSTATE: CAZIP CODE:
94806
CAPACITY:14CENSUS: 5DATE:
05/07/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Ibethys Rodriguez SolisTIME COMPLETED:
11:35 AM
NARRATIVE
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Licensing Program Analyst (LPA) Paul Petersen conducted an unannounced case management site inspection for this facility. There were five children present at the facility including 4 preschool age children in care and licensee's 10 year old relative. LPA met with assistant, Ibethys Rodriguez Solis, who was present along with the four children in care in the converted garage/daycare area along with an outside agency therapist, Daisy Ledezma, of Ed Sped Solutions.

During an inspection of this facility, LPA Petersen observed that background cleared adult, Patrick Bombard, and uncleared adult, Joseph Simon, were also present in the non-childcare areas of the residence.

The attached Type A deficiency is cited for the presence of an uncleared adult at the facility during child care hours. This citation must be corrected by the due date. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled in the facility during the next 12 months. All parents/guardians must sign an acknowledgement form of proof of receiving this report (LIC 9224). The LIC 9224 must be placed in the child’s file to be reviewed by licensing.

Assistant, Ibethys Rodriguez Solis, was provided a copy of the appeal rights (LIC9058 12/15). An exit interview was conducted, a copy of the complaint investigation report was provided, and a Notice of Site visit was provided and posted.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Paul PetersonTELEPHONE: (510) 368-2672
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2021
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: ODE, VALERIA
FACILITY NUMBER: 073409036
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/07/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/10/2021
Section Cited

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CRIMINAL RECORD CLEARANCE 102370d1 - All individuals subject to criminal record review as specified in Section 1596.87 prior to working residing, or volunteering in a licensed home, shall obtain a CA clearance or criminal record exemption as required by the department. This requirement is not being met as evidenced by LPA's observation that an
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uncleared adult, Joseph Simon, was present in the upstairs area of this residence during child care hours, posing a risk to the health and safety of children in care.
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 Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.

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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: Mayla MendozaTELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Paul PetersonTELEPHONE: (510) 368-2672
LICENSING EVALUATOR SIGNATURE:
DATE: 05/07/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/07/2021
LIC809 (FAS) - (06/04)
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