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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304205026
Report Date: 07/29/2019
Date Signed: 07/29/2019 12:15:14 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:GATES, EDITHFACILITY NUMBER:
304205026
ADMINISTRATOR:GATES, EDITHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 971-7352
CITY:ANAHEIMSTATE: CAZIP CODE:
92802
CAPACITY:14CENSUS: 11DATE:
07/29/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:31 AM
MET WITH:Edith Gates, LicenseeTIME COMPLETED:
12:30 PM
NARRATIVE
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A case management inspection was conducted by Licensing Program Analyst (LPA) Port. During today’s inspection the home and grounds were toured and the licensee was operating within the licensed capacity. capacity. There were 4 infants and 7 preschool age children present with the licensee and Assistants, Alma Arriola and Miriam Valdovinos upon arrival. A review of staff records on this date indicated that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During today's inspection the licensee did not have a children's roster available. The licensee completed a children's roster during LPA's inspection. However the licensee did not have the information readily available for all children who have attended the facility in the past 3 years. This poses a potential safety risk to children in care.

The following violation of the California Code of Regulations, Title 22; Division 12, was observed and cited today: Operation of a Family Child Care Home 102417 (g)(8) see LIC 809D.

Inspection, report review and exit interview was conducted in Spanish. Notice of Site Visit was posted during the visit. Facility representative was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Appeal rights provided and explained. The licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. Licensee was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy PortTELEPHONE: (714) 703-2815
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2019
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: GATES, EDITH
FACILITY NUMBER: 304205026
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/29/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/02/2019
Section Cited
CCR
102417(g)(8)
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Operation of a Family Child Care Home 102417(g)(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. This requirement was not met as evidenced by:
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The licensee completed a roster with the most recent children during LPA's inspection. The licensee stated she will review all children's records and complete comprehensive roster for all children who attended the facility in the past 3 years. A copy of the updated roster will be sent to our office by the due date of 08/02/2019.
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Based on LPA's observations and record review there was not a completed children's roster available for LPA's review. This poses a potential safety risk to 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: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy PortTELEPHONE: (714) 703-2815
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2019
LIC809 (FAS) - (06/04)
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