233007641-7-1-2021-01-CC-AHON-C4JT3A-20210702142157

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 233007641
Report Date: 07/01/2021
Date Signed: 07/01/2021 03:47:22 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/21/2021 and conducted by Evaluator Leticia Rosales

PUBLIC

COMPLAINT CONTROL NUMBER: 01-CC-20210421144633

FACILITY NAME:	CEJA DE LOPEZ, MARTHA FCCH		FACILITY NUMBER:	233007641
ADMINISTRATOR:	CEJA DE LOPEZ , MARTHA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(707) 462-9658
CITY:	UKIAH	STATE: CA	ZIP CODE:	95482
CAPACITY:	14	CENSUS: 12	DATE:	07/01/2021
		UNANNOUNCED	TIME BEGAN:	12:25 PM
MET WITH:	Martha Ceja De Lopez		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Licensee operated beyond the terms of the license

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Leticia Rosales-Meza conducted an unannounced subsequent complaint investigation inspection, for the purpose of delivering complaint findings, and met with the Licensee. It has been alleged that Licensee operated over capacity, specifically the Licensee was over her licensed capacity of 14 many days in March.

During the initial investigation an interview was conducted via Facetime video Tele-Inspection with Licensee on 04/28/21 at 4:50 PM. The Licensee stated she did go over her capacity with six additional children for the month of March 2021 and for the month April 2021 as well. Licensee stated that many times they (children) overlapped and she has told the parents to pick up their children earlier, but they don't. Licensee admits she did operate beyond the terms of the license, but has resolved the issue and is now operating the terms of the license

Continue on LIC9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Leticia Rosales	TELEPHONE: (707) 588-5061
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 01-CC-20210421144633

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: CEJA DE LOPEZ, MARTHA FCCH	FACILITY NUMBER: 233007641
	VISIT DATE: 07/01/2021

NARRATIVE

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The Licensee has a Large Family Child Care Home (FCCH), and the total licensed capacity for a Large Family Child Care Home shall not exceed fourteen children.

Based on the Licensee's statement and records reviewed, the allegation that Licensee operated beyond the terms of the license is Substantiated.

The following violations of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 9099D. Reports citing Type A violations are to be provided to parents/guardians of children currently in enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC9224 to be kept in each child's file. This report was reviewed and discussed with the Licensee. Appeal Rights were provided. All licensing reports are public information and must be made available upon request for at least three years.

Notice of Site Visit shall be posted for 30 days from today's visit.

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Leticia Rosales	TELEPHONE: (707) 588-5061
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2021

LIC9099 (FAS) - (06/04)

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Control Number 01-CC-20210421144633

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: CEJA DE LOPEZ, MARTHA FCCH	FACILITY NUMBER: 233007641
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/01/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/01/2021 Section Cited CCR 102416(a)	1 2 3 4 5 6 7	Staffing Ratio and Capacity. The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time. This requirement was not met as evidenced by	1 2 3 4 5 6 7	On 4/30/21 LPA Rosales-Meza received a current Facility Roster showing six children were dis-enrolled. Licensee stated she wiill stay in compliance at all times.
	8 9 10 11 12 13 14	Based on an interview conducted with the Licensee, which corroborated that the Licensee operated over her license capacity in the month of March and April 2021. This posed an immediate Health, Safety & Personal risk to the children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Leticia Rosales	TELEPHONE: (707) 588-5061
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2021

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2021

LIC9099 (FAS) - (06/04)

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