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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191806528
Report Date: 07/06/2022
Date Signed: 07/13/2022 11:22:34 AM


Document Has Been Signed on 07/13/2022 11:22 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 07/13/2022 10:59 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

NARRATIVE
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This is an amended report created by LPA Monique Ayala on 07/13/2022, to correct that the uncleared staff member Lena Aceituno is associated to the facility. However, staff has not been fingerprint cleared to be present at the facility.

On July 6, 2022 at 3:30pm, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced Case Management inspection for the purpose of assessing the health and safety of children in care. LPA was greeted by Infant/Toddler Site Supervisor Maria Birrueta who guided LPA on a tour of the facility. LPA observed 30 children in care with 9 staff. Preschool site supervisor Veronica Montano Sanchez arrived shortly after.

LPA observed staff member Lena Aceituno (S1) providing care and supervision to day care children. S1 does not have a cleared criminal record exemption. Per Guardian, S1 is associated to the facility; however fingerprints show as pending. S1 was asked to leave the facility until fingerprint clearance was granted. LPA reviewed staff file and did not observe criminal record exemption transfer request.

Based on the LPAs’ observations and records reviews, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health and safety. An immediate civil penalty of $500 is being issued today.

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). Acknowledgement of Receipt (LIC 9224 form) must be maintained in each child’s file immediately upon receipt from parent.

An exit interview was conducted was conducted and copy of this report was provided to Maria Birrueta along with Notice of Site Visit and appeal rights.

SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Monique Jessica AyalaTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 07/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/06/2022
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 07/06/2022 04:41 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: CHILDREN'S HOSPITAL CHILD DEVELOPMENT CENTER (PS)
FACILITY NUMBER: 191806528

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/06/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
07/06/2022
Section Cited

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Criminal Record Clearance: All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working...Request and be approved for a transfer of a criminal record exemption, ... the Department permits the individual to be employed...
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This requirement was not met as evidence by: Based on LPAs observation and record reivew, Lena Aceituno was observed providing care and supervision to day care children and does not have clearance. This poses an immediate health and safety risk for 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: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Monique Jessica AyalaTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 07/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/06/2022
LIC809 (FAS) - (06/04)
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